{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:32:28Z","timestamp":1792801948889,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Plantar foot ulcers are a burdensome complication of diabetes caused by abnormal foot biomechanics. Predicting foot ulcers aids in their prevention, but the value of peak pressure\u2014the most used biomechanical parameter\u2014is only moderate. We aimed to improve prediction based on the more comprehensive load measure cumulative plantar tissue stress (CPTS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively observed 60 participants with diabetes at high foot ulcer risk for 12\u2009months. At baseline, we assessed demographic and clinical characteristics\u2014including plantar pre\u2010ulcers (i.e., abundant callus, haemorrhage, blister, fissure)\u2014and measured barefoot and in\u2010shoe plantar pressures during walking and standing. Daily\u2010life weight\u2010bearing activity and adherence to prescribed footwear were assessed over 7\u2009days after baseline. The primary outcome was plantar foot ulceration during the 12\u2010month follow\u2010up. CPTS was calculated (in GPa<jats:sup>.<\/jats:sup>s\/day) from the above foot\u2010loading factors and analysed for predicting foot ulcers and its association with pre\u2010ulcers, using multivariate regression analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010two participants (37%) developed a plantar forefoot ulcer. CPTS was not a significant predictor (odds ratio (OR)\u2009=\u20090.90 (95% confidence interval (CI): 0.50\u20131.59)) but pre\u2010ulcers at baseline (OR\u2009=\u20099.97, 95%CI: 1.41\u201370.65) and walking speed (in m\/s) (OR\u2009=\u20090.01, 95%CI: 0.00\u20130.32) were. CPTS was significantly associated with pre\u2010ulcers (OR\u2009=\u20092.38, 95%CI: 1.02\u20135.54).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CPTS did not predict plantar foot ulceration in our high\u2010risk participants, but our findings support the mechanical pathway of plantar foot ulceration through pre\u2010ulcer development and indicate lower walking speed as an important predictor. Assessing walking speed and early identifying and treating pre\u2010ulcers will help predict and prevent plantar foot ulcers in high\u2010risk people with diabetes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.70099","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T04:34:23Z","timestamp":1754022863000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The predictive value of cumulative plantar tissue stress on future plantar foot ulceration in people with diabetes\u2014A 12\u2010month prospective observational study"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7941-2320","authenticated-orcid":false,"given":"Chantal M.","family":"Hulshof","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC Location University of Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Movement Sciences, Ageing &amp; Vitality and Rehabilitation &amp; Development  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"van Netten","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC Location University of Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Movement Sciences, Ageing &amp; Vitality and Rehabilitation &amp; Development  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2949-8597","authenticated-orcid":false,"given":"Tessa E.","family":"Busch\u2010Westbroek","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC Location University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise W. E.","family":"Sabelis","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Amsterdam UMC Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3410-1227","authenticated-orcid":false,"given":"Edgar J. 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