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Do Clinical Examination Variables Predict High Plantar Pressures in the Diabetic Foot?

James S. Wrobel, DPM, MS^*,, Nancy J. Birkmeyer, PhD, Jennifer L. Dercoli, DPM^* and John E. Connolly, DPM

^* Veterans Affairs Medical and Regional Office Center, White River Junction, VT.
Departments of Surgery and Community and Family Medicine, Dartmouth Medical School, Hanover, NH.
Private practice, Hanover, NH.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Department of Veterans Affairs.

Corresponding author: James S. Wrobel, DPM, MS, Veterans Affairs Medical and Regional Office Center, Surgical Service #112, White River Junction, VT 05009.

Abstract

Elevated plantar pressures are an important predictor of diabetic foot ulceration. The objective of this study was to determine which clinical examination variables predict high plantar pressures in diabetic feet. In a cross-sectional study of 152 male veterans with diabetes mellitus, data were collected on demographics, comorbid conditions, disease severity, neuropathy status, vascular disease, and orthopedic and gait examinations. Univariate predictors included height, weight, body surface area, body weight per square inch of foot surface area, bunion deformity, hammer toe, Romberg’s sign, insensitivity to monofilament, absent joint position sense, decreased ankle dorsiflexion, and fat pad atrophy. Variables that remained significantly associated with high plantar pressures (4 kg/cm²) in multivariate analysis included height, body weight per square inch of foot surface area, Romberg’s sign, and insensitivity to monofilament. These results may be useful in identifying patients who would benefit from interventions designed to decrease plantar foot pressures. (J Am Podiatr Med Assoc 93(5): 367-372, 2003)

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