Foot Biomechanics in Patients with Diabetes Mellitus

Journal of the American Podiatric Medical Association - Tập 101 Số 3 - Trang 208-214 - 2011
José Luís Lázaro‐Martínez1, Javier Aragón‐Sánchez1, Juan Vicente Benéit Montesinos1, Máximo A. González Jurado1, Esther García Morales1, David Martínez Hernández1
1Diabetic Foot Unit, University Podiatric Clinic, College of Podiatry, Universidad Complutense de Madrid, Madrid, Spain

Tóm tắt

Background:We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities.Methods:This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed.Results:No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039).Conclusions:Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors. (J Am Podiatr Med Assoc 101(3): 208–214, 2011)

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Tài liệu tham khảo

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Mueller, 2003, Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy., J Biomech, 36, 1009, 10.1016/S0021-9290(03)00078-2

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Gutierrez, 2001, Mild diabetic neuropathy affects ankle motor function., Clin Biomech (Bristol, Avon), 16, 522, 10.1016/S0268-0033(01)00034-1

Boulton, 1986, Impaired vibratory perception and diabetic foot ulceration., Diabet Med, 3, 335, 10.1111/j.1464-5491.1986.tb00775.x

Apelqvist, 2008, Practical guidelines on the management and prevention of the diabetic foot: based upon the International Consensus on the Diabetic Foot (2007): prepared by the International Working Group on the Diabetic Foot., Diabetes Metab Res Rev, 24, S181, 10.1002/dmrr.848

Lobmann, 2002, Association of increased plantar pressures with peripheral sensorimotor and peripheral autonomic neuropathy in Type 2 diabetic patients., Diabetes Nutr Metab, 15, 165

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Menz, 2005, Footwear characteristics and foot problems in older people., Gerontology, 51, 346, 10.1159/000086373

Bus, 2009, Role of intrinsic muscle atrophy in the etiology of claw toe deformity in diabetic neuropathy may not be as straightforward as widely believed., Diabetes Care, 32, 1063, 10.2337/dc08-2174

Nube, 2006, Biomechanical risk factors associated with neuropathic ulceration of the hallux in people with diabetes mellitus., JAPMA, 96, 189, 10.7547/0960189

Aström, 1995, Alignment and joint motion in the normal foot., J Orthop Sports Phys Ther, 22, 216, 10.2519/jospt.1995.22.5.216

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Bus, 2002, Intrinsic muscle atrophy and toe deformity in the diabetic neuropathic foot: a magnetic resonance imaging study., Diabetes Care, 25, 1444, 10.2337/diacare.25.8.1444

Reihsner, 2000, Alterations of biochemical and two-dimensional biomechanical properties of human skin in diabetes mellitus as compared to effects of in vitro non-enzymatic glycation., Clin Biomech (Bristol, Avon), 15, 379, 10.1016/S0268-0033(99)00085-6

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Journal of the American Podiatric Medical Association

Tập 101 Số 3

208-214

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