Biomechanics of the Diabetic Foot: The Road to Foot Ulceration

Schie, Carine van; Slim, Frederik J.

doi:10.1385/1-59259-168-x:147

Cited by 4 publications

(3 citation statements)

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“…The most common causal pathway to diabetic foot ulceration involves the confluence of loss of sensation resulting in failure to detect repetitive pressure or trauma and abnormal foot structure or deformity producing sites of abnormally high pressure, usually over areas of bony prominence (Mueller et al, 1990;Brem et al, 2006;Chao and Cheing, 2009;O'Loughlin et al, 2010). Diabetic peripheral polyneuropathy is the central component as it can induce changes in foot structure and produce dryness of the skin which can lead to callus formation (van Schie, 2006;O'Loughlin et al, 2010). Callosities form on areas of elevated pressure on the plantar aspect of the foot in response to pressure amplified by restricted joint motion of the ankle and foot which is applied to dry, poorly lubricated skin resulting from autonomic dysfunction .…”

Section: Pathophysiology Of Diabetic Foot Ulcerationmentioning

confidence: 99%

Diabetic foot ulceration and amputation

Burns¹,

Jan²

2012

Rehabilitation Medicine

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Section: Pathophysiology Of Diabetic Foot Ulcerationmentioning

confidence: 99%

Diabetic foot ulceration and amputation

Burns¹,

Jan²

2012

Rehabilitation Medicine

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“…The most likely explanation of such an observation which the authors' proposed is the offloading theory which suggest that people with active ulceration protect the part of the foot where the ulceration exist which has an impact on the pressure measurement results. It is assumed currently that, appeared to foot ulcers, high plantar pressure must coexist with neuropathy [23–25]. The other author [26], however, observed 28% incidence of ulceration in patients with peripheral neuropathy and high plantar pressure but did not confirm the presence of ulcers in patients with neuropathy but without abnormal plantar pressure.…”

Section: Introductionmentioning

confidence: 99%

Distribution of the Highest Plantar Pressure Regions in Patients with Diabetes and Its Association with Peripheral Neuropathy, Gender, Age, and BMI: One Centre Study

Sutkowska

Sutkowski

Sokołowski

et al. 2019

Journal of Diabetes Research

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The abnormal plantar pressure distribution and value play a key role in the formation of plantar calluses and diabetic foot ulcer. The prevalence of the highest pressure different distribution and its association with various factors among patients with diabetes is not well known. The study purpose was to evaluate the prevalence of different regions for the highest pressure on the sole and its association with selected factors among patients with diabetes. Medical records of nonulcer patients were retrospectively analysed. The relationship between pressure patterns on the sole obtained during a pedobarographic test as a semiquantitative assessment with colourful print analysis and neuropathy, gender, age, and BMI was searched. The most common location of the highest pressure was the central part of the forefoot. No association was found between the different highest pressure regions and age, sensory neuropathy, calluses, and foot deformities. The highest pressure on the lateral part of the foot and midfoot was observed more often in females and in patients with a BMI≥35. The prevalence of the highest pressure on the forefoot was more common in patients with a BMI<35. Conclusions. The most frequent regions of the highest pressure on the sole in patients with diabetes were the central part of the forefoot (2-3 metatarsal heads) with no simple relationship to the assessed variables other than BMI<35. Female gender and higher BMI seem to be responsible for shifting the place of the highest pressure to other places of the foot.

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“…Several studies (Mueller, 1992) (Loerakker et al, 2011) recognized at least three mechanisms leading to pressure ulcer: (1) ischemia caused by increased pressure duration even for low induced strains, (2) high internal tissue strains created by increased pressure magnitude, and/or (3) tissue fatigue caused by increased number of periodic pressure loads. Time and strain have an inversely proportional contribution to ulceration (Kosiak, 1959) (Loerakker et al, 2011) (Van Schie et al, 2006): high strains take a relatively short time (a few minutes) to cause ulceration whereas low strains induce lesion after a longer period (between two and four hours). Short and long term lesion inducing strain thresholds have been characterized by (Loerakker et al, 2011) in muscle tissues.…”

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Clinical workflow for personalized foot pressure ulcer prevention

Bucki¹,

Luboz²,

Perrier

et al. 2016

Medical Engineering & Physics

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Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and "cluster volumes" (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer.

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Biomechanics of the Diabetic Foot: The Road to Foot Ulceration

Cited by 4 publications

References 0 publications

Diabetic foot ulceration and amputation

Diabetic foot ulceration and amputation

Distribution of the Highest Plantar Pressure Regions in Patients with Diabetes and Its Association with Peripheral Neuropathy, Gender, Age, and BMI: One Centre Study

Clinical workflow for personalized foot pressure ulcer prevention

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