Plantar Shear Stress in Individuals With a History of Diabetic Foot Ulcer: An Emerging Predictive Marker for Foot Ulceration

Plantar shear stress has been held accountable as a causative factor in diabetic foot ulcers (DFU) (1,2). Delbridge et al. (2) recognized shear stress as a major causative factor by stating that it is shear rather than vertical load that is responsible for tissue breakdown that occurs deep to the skin. Historically, research in this area has been hampered by an underestimation of the importance of shear stress and the lack of technology to measure it. Emerging evidence within the past decade has demonstrated the clinical significance of shear to foot ulceration (3–5). We previously revealed that individuals with diabetic neuropathy (DN) experience higher plantar shear compared with control subjects (5). However, to our knowledge, no study has compared peak shear in individuals with a history of DFU to those patients with DN but no history of DFU.We quantified peak plantar shear (PS) in 9 subjects with (DFU) and 16 DN subjects without (DN) previous ulcers …