Waaijman et al identified factors associated with a recurrent neuropathic plantar ulcer in a diabetic. These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Amsterdam, Medisch Spectrum Twente and Maxima Medical Centre in The Netherlands.

Patient selection: diabetic with history of neuropathic plantar foot ulcer


Risk factors for recurrence:

(1) presence of a minor lesion (odds ratio 9.1)

(2) cumulative duration of past foot ulcers in months (odds ratio 1.03)

(3) barefoot peak plantar pressure


Factors associated with lower risk of recurrence:

(1) day-to-day variation in stride count (odds ratio 0.93)

(2) in-shoe peak pressure < 200 kPa with footwear adherence > 80% (odds ratio 0.43)


Unrecognized repetitive trauma is believed to be the underlying cause and offloading footwear can reduce the risk.

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