Biomechanics of the Diabetic Foot

2018 ◽  
Author(s):  
Paul J Kim
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
The Body ◽  
Foot And Ankle ◽  
Foot Deformity ◽  
Shear Forces ◽  
Functional Capabilities ◽  
Key Words Biomechanics

The lower extremity is uniquely equipped to withstand the demands of ambulation that involve a complex orchestration of events to efficiently propel the body forward. The reparative properties and functional capabilities are compromised in the diabetic foot and ankle. Therefore, the diabetic foot is at risk for the development of a chronic ulcer or necessitates the need for an amputation. Unique forces are experienced in the lower extremity during ambulation. Specifically, sagittal and shear forces are less tolerated in the diabetic foot. This chapter discusses the normal and abnormal biomechanics of the diabetic foot and ankle that lead to the development of an ulcer and promote its chronicity. Further, a biomechanical-focused conservative and surgical approach to prevention, treatment, and methods to curtail recidivism will be addressed. This review contains 7 figures, 3 tables, and 42 references. Key Words: biomechanics, diabetic foot ulcer, foot deformity, function, offloading, plantar pressure, recidivism, shear

scholarly journals Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)—Two-Year Follow-Up Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Leila Yazdanpanah ◽  
Hajieh Shahbazian ◽  
Iraj Nazari ◽  
Hamid Reza Arti ◽  
Fatemeh Ahmadi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Univariate Analysis ◽  
Previous History ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Population Based ◽  
University Hospital ◽  
Foot Deformity ◽  
History Of

Aim/Introduction. This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU). Materials and Methods. In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression. Results. Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89–8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13–43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37–14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33–7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40–8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10–8.29), P value = 0.032] had a statistically significant relationship with DFU incidence. Conclusion. Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.

Lower-extremity arterial revascularization: Is there any evidence for diabetic foot ulcer-healing?

2016 ◽  
Vol 42 (1) ◽  
pp. 4-15 ◽  
Author(s):  
J. Vouillarmet ◽  
O. Bourron ◽  
J. Gaudric ◽  
P. Lermusiaux ◽  
A. Millon ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Ulcer Healing ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Arterial Revascularization

scholarly journals A study on diabetes mellitus among diabetic foot ulcer patients in a tertiary care centre

2017 ◽  
Vol 4 (5) ◽  
pp. 1555
Author(s):  
Vinu Gopinath ◽  
S. Soundara Rajan
Keyword(s):  
Diabetes Mellitus ◽  
Blood Sugar ◽  
Diabetic Foot ◽  
Blood Sugar Level ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
The Body ◽  
Care Centre ◽  
Tertiary Care Centre

Background: Diabetes mellitus is a chronic disease which occurs either when the pancreas does not reproduce enough insulin, the hormone that regulates blood sugar level or when the body cannot effectively use the insulin it produces. Hyperglycemia or raised blood sugar level is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the system of the body especially nerves and blood vessels. Diabetes mellitus has become the cause for growing public health concern in developing countries as it has been for a long time in most developed ones. The reason for increase in prevalence of diabetes mellitus in developing countries may include unhealthy life style, rapid westernization, poor knowledge, negative attitude and poor practice towards diabetes mellitus among general population. Objective of the study was to find out the knowledge, and awareness towards diabetes mellitus among diabetic foot ulcer patients attending in a tertiary care Centre.Methods: A cross sectional study was carried out in the surgical outpatient department of a tertiary care Centre. All diabetic foot ulcer patients attending surgical outpatient department for the period of two months was included. Juvenile diabetic patients, Type II diabetes mellitus patients with co morbidities are excluded.Results: Out of the 100-study participant’s majority are males (61%). 55% of the study participants are not aware of the major cause of diabetes mellitus. 92% of the population knew the accurate method of monitoring diabetes mellitus. 70.6% of people are aware of normal blood sugar level. 51% of people are aware of the complications of diabetes mellitus and 84.3% of people know the symptoms of diabetes mellitus. 68.6% of the population knew regular exercise can control diabetes mellitus yet only 50.8% of population exercise regularly.Conclusions: This study reflects that there is a need to improve diabetic knowledge among the patients which can be achieved through health education.

scholarly journals Lower-Extremity Amputation Risk After Charcot Arthropathy and Diabetic Foot Ulcer

Diabetes Care ◽  
2009 ◽  
Vol 33 (1) ◽  
pp. 98-100 ◽  
Author(s):  
M.-W. Sohn ◽  
R. M. Stuck ◽  
M. Pinzur ◽  
T. A. Lee ◽  
E. Budiman-Mak
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Extremity Amputation ◽  
Charcot Arthropathy ◽  
Extremity Amputation

scholarly journals Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer

Diabetes Care ◽  
2015 ◽  
Vol 38 (5) ◽  
pp. 852-857 ◽  
Author(s):  
Kristy Pickwell ◽  
Volkert Siersma ◽  
Marleen Kars ◽  
Jan Apelqvist ◽  
Karel Bakker ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Lower Extremity Amputation ◽  
Extremity Amputation

The Economic Value of Specialized Lower-Extremity Medical Care by Podiatric Physicians in the Treatment of Diabetic Foot Ulcers

2011 ◽  
Vol 101 (2) ◽  
pp. 93-115 ◽  
Author(s):  
Ginger S. Carls ◽  
Teresa B. Gibson ◽  
Vickie R. Driver ◽  
James S. Wrobel ◽  
Matthew G. Garoufalis ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Medical Care ◽  
Diabetic Foot ◽  
Net Present Value ◽  
Economic Value ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Patients At Risk

Background: We sought to examine the economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers by evaluating cost outcomes for patients with diabetic foot ulcer who did and did not receive care from a podiatric physician in the year before the onset of a foot ulcer. Methods: We analyzed the economic value among commercially insured patients and Medicare-eligible patients with employer-sponsored supplemental medical benefits using the MarketScan Databases. The analysis consisted of two parts. In part I, we examined cost or savings per patient associated with care by podiatric physicians using propensity score matching and regression techniques; in part II, we extrapolated cost or savings to populations. Results: Matched and regression-adjusted results indicated that patients who visited a podiatric physician had $13,474 lower costs in commercial plans and $3,624 lower costs in Medicare plans during 2-year follow-up (P &lt; .01 for both). A positive net present value of increasing the share of patients at risk for diabetic foot ulcer by 1% was found, with a range of $1.2 to $17.7 million for employer-sponsored plans and $1.0 to $12.7 million for Medicare plans. Conclusions: These findings suggest that podiatric medical care can reduce the disease and economic burdens of diabetes. (J Am Podiatr Med Assoc 101(2): 93–115, 2011)

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