Predictive diabetic foot ulcer risk factors correlated with elevated forefoot peak plantar pressure

Abstract

Polyneuropathy and foot deformity, such as Claw and hammer-toes (CHT), together with hyperkeratosis, are predictive diabetic foot ulcer (DFU) factors. These factors are correlated with increased forefoot peak plantar pressure (PPP). Increased PPP at metatarsal heads is correlated with forefoot DFU development. The aim of this study was to observe that the presence of CHT, hyperkeratosis and polyneuropathy is correlated with high forefoot PPP (FPPP). An observational transversal survey with 103 diabetic patients, with or without CHT, hyperkeratosis and polyneuropathy, and without peripheral arterial disease, previous or current DFU and lower limb amputation was conducted. Mean age was 74 years old, 41 male and 62 women. Variables were CHT, hyperkeratosis, polyneuropathy and FPPP of each foot. PPP was obtained through the BIOFOOT/IBV baropodometric system. An analysis of difference between means of two samples was performed. “Hyperkeratosis” is correlated with higher FPPP than “CHT and hyperkeratosis”, and both with higher FPPP than those who had none of these features. There is no significant difference between FPPP of the groups without and with polyneuropathy, both without hyperkeratosis. Hyperkeratosis is correlated with higher FPPP, independently of polyneuropathy. The mean FPPP of up to 840 KpPa may be considered as indicative of a lower risk of DFU, in this sample and with this baropodometric system.