Plantar shear stress: Is it the H pylori of diabetic foot ulcers?

      It has been a long time since the systematic research on diabetic foot biomechanics has started thanks to the efforts by Paul Brand and investigators inspired by Brand. While investigating diabetic foot ulcers (DFU), Brand realized the significance of biomechanics in formation and treatment of ulcers: “the problem of ulceration will finally be conquered only when it is realized that the damage to the foot is not a problem of medicine, it is a problem of mechanics.” (
      • Brand P.
      Prof. Paul Brand Gives a Master Class in Diabetic Foot Biomechanics.
      ) Since then, many investigators focused on diabetic foot biomechanics in order to better understand the “problem of mechanics” in DFU and finding effective prevention tools and methods. A vast majority of these studies explored plantar pressures as the primary causative factor behind DFU. As a result, numerous shoe insoles and other type of footwear have been developed in order to reduce foot pressures and hence prevent DFU.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Armstrong D.G.
        • Peters E.J.
        • Athanasiou K.A.
        • Lavery L.A.
        Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration?.
        J. Foot Ankle Surg. 1998; 37: 303-307
        • Brand P.
        Prof. Paul Brand Gives a Master Class in Diabetic Foot Biomechanics.
        Youtube, 2018
        • Geiss L.S.
        • Li Y.
        • Hora I.
        • Albright A.
        • Rolka D.
        • Gregg E.W.
        Resurgence of diabetes e related non traumatic lower-extremity amputation in the young and middle-aged adult US population.
        Diabetes Care. 2019; 42: 50-54
        • Hall O.C.
        • Brand P.W.
        The etiology of the neuropathic plantar ulcer: a review of the literature and a presentation of current concepts.
        JAPMA. 1979; 69: 173-177
        • Kokate J.Y.
        • Leland K.J.
        • Held A.M.
        • Hansen G.L.
        • Johnson B.A.
        • Wilke M.S.
        • Sparrow E.M.
        • Iaizzo P.
        Temperature-modulated pressure ulcers: a porcine model.
        Arch. Phys. Med. Rehabil. 1995; 76: 666-673
        • Lavery L.A.
        • Vela S.A.
        • Fleischli J.G.
        • Armstrong D.C.
        • Lavery D.C.
        Reducing plantar pressure in the neuropathic foot. A comparison of footwear.
        Diabet. Care. 1997; 20: 1706-1710
        • Lavery L.A.
        • Armstrong D.G.
        • Wunderlich R.P.
        • Tredwell J.
        • Boulton A.J.
        Predictive value of foot pressure assessment as part of a population e based diabetes disease management program.
        Diabet. Care. 2003; 26: 1069-1073
        • Yavuz M.
        Pathomechanics of diabetic foot ulceration: revisiting plantar shear and temperature.
        in: Gefen Amit The Science, Etiology and Mechanobiology of Diabetes and Its Complications. Academic Press, 2021
        • Yavuz M.
        • Tajaddini A.
        • Botek G.
        • Davis B.L.
        Temporal characteristics of plantar shear distribution: relevance to diabetic patients.
        J. Biomech. 2008; 41: 556-559
        • Yavuz M.
        • Husni E.
        • Botek G.
        • Davis B.L.
        Plantar shear stress distribution in patients with rheumatoid arthritis: relevance to foot pain.
        JAPMA. 2010; 100: 265-269
        • Yavuz M.
        • Ersen A.
        • Richardson M.
        • et al.
        Biomechanical efficacy of shear-reducing diabetic insoles: elaborations on future design criteria.
        JPO. 2019; 31: 82-86