Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration

Fernando, Malindu E., Crowther, Robert G., Lazzarini, Peter A., Sangla, Kunwarjit S., Wearing, Scott, Buttner, Petra, and Golledge, Jonathan (2016) Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration. BMC Endocrine Disorders, 16 (51). pp. 1-10.

PDF (Published Version) - Published Version
Available under License Creative Commons Attribution.

Download (525kB) | Preview
View at Publisher Website:


Background: Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls).

Methods: Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm's correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen's d values (standardised mean difference) were reported for all significant outcomes.

Results: The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p < 0.05). The stance phase duration was also significantly higher in cases compared to both control groups (p < 0.05). The main limitations of the study were the small number of cases studied and the inability to adjust analyses for multiple factors.

Conclusions: This study shows that plantar pressures are higher in cases with active diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration.

Item ID: 46117
Item Type: Article (Research - C1)
ISSN: 1472-6823
Keywords: diabetic foot disease, biomechanics, plantar ulcers, peripheral diabetic neuropathy, foot ulceration, plantar pressure, offloading
Additional Information:

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Funders: Queensland Department of Health, James Cook University (JCU), National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: JCU Graduate Research School , JCU College of Medicine
Research Data:
Date Deposited: 12 Oct 2016 07:38
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
Downloads: Total: 1071
Last 12 Months: 56
More Statistics

Actions (Repository Staff Only)

Item Control Page Item Control Page