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Dynamic Foot Pressure and Other Studies as Diagnostic and Management Aids in Diabetic Neuropathy
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1983
Year
HypertensionGroup ALower Limb TraumaOrthopaedic SurgeryManagement AidsKinesiologyBiomechanicsDiabetic NeuropathyFoot UlcerationApplied PhysiologyNeurologyNeuropathologyHealth SciencesDiabetes ManagementDynamic Foot PressureOther InvestigationsRehabilitationPhysical TherapyDiabetesLower Extremity WoundPathological GaitDiabetes MellitusPodiatryHuman MovementMedicine
Foot pressure and related neurophysiological tests were measured in 123 subjects across diabetic neuropathy, non‑neuropathic diabetic, and nondiabetic groups using a microprocessor‑controlled optical system and additional bedside assessments. High metatarsal‑head pressures were found in 51 % of neuropathic feet, correlating strongly with ulcer history, and bedside tests—especially vibration perception threshold—identified ulcer risk, suggesting that VPT alone and foot‑pressure mapping can aid prediction and management of diabetic foot ulcers.
The pressures and loads under the feet during walking have been compared in three groups of 41 patients each, using a microprocessor-controlled optical system. Group A consisted of patients with diabetic neuropathy, group B of non-neuropathic diabetic patients, and group C of nondiabetic controls. Thirteen patients in group A had a history of neuropathic foot ulceration. Other investigations in the diabetic patients included motor conduction velocity (MCV) in the median and peroneal nerves, vibration perception threshold (VPT) in the great toes, the valsalva response (VR), skin resistance (SR), and the ankle pressure index (API). Fifty-one percent of neuropathic feet had abnormally high pressures underneath the metatarsal heads compared with 17% of the diabetic controls and 7% of nondiabetic subjects. All those feet with previous ulceration had abnormally high pressures at the ulcer sites. Of the other investigations, the VPT correlated most significantly with the presence of foot ulceration. In addition, a low median and peroneal nerve MCV, an abnormal VR, a high API, and the absence of sweating all correlated with the presence of foot ulceration. We therefore conclude that simple bedside investigations, such as measurement of the VPT alone, may be useful in identifying those patients at risk of foot ulceration. Foot pressure studies may then be used in such patients as a predictive and management aid by determining specific areas under the foot that are prone to ulceration.