Article

In plantar pressure studies on diabetic footwear, both the maximum
peak pressure (MPP) and peak pressure-time integral (PTI) are often reported.
However, specific conclusions for each parameter are not commonly reported,
suggesting these parameters may be interchangeable. The aim was to explore the
interdependency of MPP and PTI in diabetic patients wearing different types of
footwear. METHODS: In-shoe plantar pressure was measured in 69 neuropathic
diabetic patients who walked in custom made footwear, forefoot offloading shoes,
cast shoes, and/or standard footwear. For each of six anatomical foot regions,
correlation coefficients were calculated between MPP and PTI. To assess parameter
congruency, the percentage of patients showing correlation coefficients >0.7 or
coefficients of variation for both MPP and PTI <10%, was calculated. RESULTS:
Across all footwear conditions, MPP and PTI were highly correlated in the
forefoot and midfoot (r>0.78 in all but one foot region in one footwear
condition). Lower correlations coefficients were found in the rearfoot
(r=0.43-0.45). Across regions, between 46% and 87% of patients (mean 72%) showed
parameter congruency in the forefoot and midfoot. CONCLUSIONS: The results showed
that the MPP and PTI are highly interdependent in those foot regions most at risk
for plantar ulceration in patients wearing commonly prescribed footwear. Since
MPP has been shown to date to be the clinically more relevant parameter of the
two, these results suggest that the value of reporting PTI in addition to MPP in
the same diabetic footwear study is small.
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