TY - JOUR
T1 - Pressure gradient and subsurface shear stress on the neuropathic forefoot
AU - Lott, Donovan J.
AU - Zou, Dequan
AU - Mueller, Michael J.
N1 - Funding Information:
Funding was provided by the Foundation for Physical Therapy, Inc. (Promotion of Doctoral Studies I and II scholarships awarded to DJL) and the National Center for Medical Rehabilitation Research, the National Institutes of Health Grant RO1 HD36895. The authors acknowledge the Volunteer for Health program at Washington University School of Medicine and the Prevention and Control Research Core of the Washington University Diabetes Research and Training Center (P60 DK20579) for their assistance in subject recruitment.
PY - 2008/3
Y1 - 2008/3
N2 - Background: Stresses within the neuropathic foot's tissues can be estimated by pressure distributions and may provide information regarding the potential for skin breakdown. The purposes of this study were to: (1) determine the magnitude of peak plantar pressure, pressure time integral, peak pressure gradient, and peak maximum shear stress; and (2) determine the association of these variables with one another. Methods: Forefoot peak plantar pressure, pressure time integral, peak pressure gradient, peak maximal shear stress, and depth of peak maximal shear stress were calculated for 16 controls, 16 people with diabetic neuropathy, and 22 people with diabetic neuropathy and a history of ulceration from pressure assessments. Findings: Peak plantar pressure, pressure gradient, and maximal shear stress were greater in subjects with a history of ulceration relative to control subjects (P < 0.03), pressure gradient was greater in subjects with diabetic neuropathy and a history of ulceration compared to subjects with diabetic neuropathy and no history of ulceration (P < 0.02), and depth of maximal shear stress was less in both groups of subjects with diabetic neuropathy compared to controls (P < 0.03). Strong relationships existed between the variables. Interpretation: Although these variables are associated with one another, peak pressure gradient and peak maximal shear stress provide information concerning plantar pressure distribution and the potentially injurious internal stresses within the foot's soft tissues. Peak pressure gradient and peak maximal shear stress may perhaps be more discriminating than peak plantar pressure alone in distinguishing between groups of individuals who are at risk for developing a foot ulcer.
AB - Background: Stresses within the neuropathic foot's tissues can be estimated by pressure distributions and may provide information regarding the potential for skin breakdown. The purposes of this study were to: (1) determine the magnitude of peak plantar pressure, pressure time integral, peak pressure gradient, and peak maximum shear stress; and (2) determine the association of these variables with one another. Methods: Forefoot peak plantar pressure, pressure time integral, peak pressure gradient, peak maximal shear stress, and depth of peak maximal shear stress were calculated for 16 controls, 16 people with diabetic neuropathy, and 22 people with diabetic neuropathy and a history of ulceration from pressure assessments. Findings: Peak plantar pressure, pressure gradient, and maximal shear stress were greater in subjects with a history of ulceration relative to control subjects (P < 0.03), pressure gradient was greater in subjects with diabetic neuropathy and a history of ulceration compared to subjects with diabetic neuropathy and no history of ulceration (P < 0.02), and depth of maximal shear stress was less in both groups of subjects with diabetic neuropathy compared to controls (P < 0.03). Strong relationships existed between the variables. Interpretation: Although these variables are associated with one another, peak pressure gradient and peak maximal shear stress provide information concerning plantar pressure distribution and the potentially injurious internal stresses within the foot's soft tissues. Peak pressure gradient and peak maximal shear stress may perhaps be more discriminating than peak plantar pressure alone in distinguishing between groups of individuals who are at risk for developing a foot ulcer.
KW - Diabetes mellitus
KW - Foot ulceration
KW - Plantar pressure
UR - http://www.scopus.com/inward/record.url?scp=39149083445&partnerID=8YFLogxK
U2 - 10.1016/j.clinbiomech.2007.10.005
DO - 10.1016/j.clinbiomech.2007.10.005
M3 - Article
C2 - 18060668
AN - SCOPUS:39149083445
SN - 0268-0033
VL - 23
SP - 342
EP - 348
JO - Clinical Biomechanics
JF - Clinical Biomechanics
IS - 3
ER -