Hulshof Chantal M, van Netten Jaap J, Busch-Westbroek Tessa E, Sabelis Louise W E, Peters Edgar J G, Pijnappels Mirjam, Bus Sicco A
Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, Amsterdam, The Netherlands.
Diabet Med. 2025 Oct;42(10):e70099. doi: 10.1111/dme.70099. Epub 2025 Jul 31.
Plantar foot ulcers are a burdensome complication of diabetes caused by abnormal foot biomechanics. Predicting foot ulcers aids in their prevention, but the value of peak pressure-the most used biomechanical parameter-is only moderate. We aimed to improve prediction based on the more comprehensive load measure cumulative plantar tissue stress (CPTS).
We prospectively observed 60 participants with diabetes at high foot ulcer risk for 12 months. At baseline, we assessed demographic and clinical characteristics-including plantar pre-ulcers (i.e., abundant callus, haemorrhage, blister, fissure)-and measured barefoot and in-shoe plantar pressures during walking and standing. Daily-life weight-bearing activity and adherence to prescribed footwear were assessed over 7 days after baseline. The primary outcome was plantar foot ulceration during the 12-month follow-up. CPTS was calculated (in GPas/day) from the above foot-loading factors and analysed for predicting foot ulcers and its association with pre-ulcers, using multivariate regression analyses.
Twenty-two participants (37%) developed a plantar forefoot ulcer. CPTS was not a significant predictor (odds ratio (OR) = 0.90 (95% confidence interval (CI): 0.50-1.59)) but pre-ulcers at baseline (OR = 9.97, 95%CI: 1.41-70.65) and walking speed (in m/s) (OR = 0.01, 95%CI: 0.00-0.32) were. CPTS was significantly associated with pre-ulcers (OR = 2.38, 95%CI: 1.02-5.54).
CPTS did not predict plantar foot ulceration in our high-risk participants, but our findings support the mechanical pathway of plantar foot ulceration through pre-ulcer development and indicate lower walking speed as an important predictor. Assessing walking speed and early identifying and treating pre-ulcers will help predict and prevent plantar foot ulcers in high-risk people with diabetes.
足底溃疡是由足部生物力学异常导致的糖尿病的一种负担沉重的并发症。预测足部溃疡有助于预防，但峰值压力（最常用的生物力学参数）的预测价值仅为中等。我们旨在基于更全面的负荷测量指标——累积足底组织应力（CPTS）来改善预测。
我们前瞻性地观察了60名足部溃疡高风险的糖尿病患者12个月。在基线时，我们评估了人口统计学和临床特征，包括足底前期溃疡（即大量胼胝、出血、水泡、裂隙），并测量了行走和站立时的赤脚和穿袜足底压力。在基线后7天评估日常生活负重活动和对规定鞋具的依从性。主要结局是12个月随访期间的足底溃疡。根据上述足部负荷因素计算CPTS（以GPa/天为单位），并使用多变量回归分析来分析其对足部溃疡的预测作用及其与前期溃疡的关联。
22名参与者（37%）发生了足底前足溃疡。CPTS不是一个显著的预测指标（比值比（OR）=0.90（95%置信区间（CI）：0.50 - 1.59）），但基线时的前期溃疡（OR = 9.97，95%CI：1.41 - 70.65）和行走速度（以m/s为单位）（OR = 0.01，95%CI：0.00 - 0.32）是显著的预测指标。CPTS与前期溃疡显著相关（OR = 2.38，95%CI：1.02 - 5.54）。
CPTS未能在我们的高风险参与者中预测足底溃疡，但我们的研究结果支持通过前期溃疡发展导致足底溃疡的机械途径，并表明较低的行走速度是一个重要的预测指标。评估行走速度以及早期识别和治疗前期溃疡将有助于预测和预防糖尿病高风险人群的足底溃疡。
