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Manchester Diabetes Centre, UK.
Clinical observation suggests that neuropathic foot ulceration frequently occurs beneath plantar callosities and in areas of high dynamic shear and vertical stress underneath the foot during walking. Seventeen diabetic patients had dynamic foot pressure measurements made before and after the removal of a total of 43 forefoot plantar callosities. Peak pressures (mean +/- SE) in the treated areas were reduced by 26% from 14.2 +/- 1.0 to 10.3 +/- 0.9 kg cm-2 (p less than 0.001), with reductions at 37 of the 43 sites and in all patients. Mean heel pressures were not significantly different (5.0 +/- 0.6 vs 4.9 +/- 0.6 kg cm-2). These results suggest that callus may act as a foreign body elevating plantar pressures and that a significant reduction in pressure is achieved by local chiropody treatment.
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