Pressure gradient and subsurface shear stress on the neuropathic forefoot

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.