Intrinsic foot muscle and plantar tissue changes in type 2 diabetes mellitus

Kumar, C. G. Shashi; Rajagopal, KV; Hande, Manjunath; Maiya, Arun G.; Mayya, Shreemathi S

doi:10.1111/1753-0407.12254

Cited by 30 publications

(40 citation statements)

References 19 publications

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“…The higher plantar pressure in neuropathy could be seen as reduction in plantar tissue thickness in diabetes population. The plantar tissue thickness was reported in two studies (Kumar et al 2015 ; Zheng et al 2006 ). The former study used the ultrasound indentation system to assess the tissue thickness whereas the other study used the diagnostic ultrasound in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis

et al. 2016

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Background Diabetes mellitus patients are at increased risk of developing diabetic foot with peripheral neuropathy, vascular and musculoskeletal complications. Therefore they are prone to develop frequent and often foot problems with a relative high risk of infection, gangrene and amputation. In addition, altered plantar pressure distribution is an important etiopathogenic risk factor for the development of foot ulcers. Thus the review on study of foot kinematic and kinetic in type 2 diabetes mellitus to understand the biomechanical changes is important.Methodology Scientific articles were obtained using electronic databases including Science Direct, CINAHL, Springer Link, Medline, Web of Science, and Pubmed. The selection was completed after reading the full texts. Studies using experimental design with focus on biomechanics of diabetic foot were selected.ResultsThe meta-analysis report on gait velocity (neuropathy = 128 and non-diabetes = 131) showed that there was a significantly lower gait velocity in neuropathy participants compared to non-diabetes age matched participants at a high effect level (−0.09, 95 % CI −0.13 to 0.05; p < 0.0001). Regarding knee joint flexion range there was a significant difference between neuropathy and non-diabetes group (4.75, 95 % CI, −7.53 to 1.97, p = 0.0008).ConclusionsThe systematic review with meta-analysis reported significant difference in kinematic and kinetic variables among diabetic with neuropathy, diabetic without neuropathy and non-diabetes individuals. The review also found that the sample size in some studies were not statistically significant to perform the meta-analysis and report a strong conclusion. Therefore a study with higher sample size should be done.

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Section: Discussionmentioning

confidence: 99%

Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis

et al. 2016

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“…Ultrasound outcomes assessed were intrinsic foot muscle (IFM) dimensions [ 29 – 31 ], plantar heel pad thickness [ 32 – 38 ], forefoot soft tissue thickness [ 28 , 30 , 36 , 38 – 40 ] and plantar skin thickness [ 30 , 41 , 42 ]. Distance and area measurements were standardised to millimetres (mm) or square millimetres (mm 2 ) respectively.…”

Section: Resultsmentioning

confidence: 99%

Can ultrasound measures of intrinsic foot muscles and plantar soft tissues predict future diabetes-related foot disease? A systematic review

et al. 2018

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IntroductionDiabetes mellitus (DM) is associated with hyperglycaemia and advanced glycosylation end-products. In the foot, the consequences of chronic or uncontrolled diabetes are micro and macrovascular disease, neuropathy, reduced joint mobility and structural and soft tissue changes that increase the risk of ulcer development and amputation. Diabetes foot assessment currently includes a comprehensive history, neurological and vascular assessments and examination focussed on dermatological and musculoskeletal abnormalities. Whilst these assessments are helpful for predicting ulceration risk, direct identifiers that enable early therapeutic intervention are lacking. The intention of this review was to ascertain if B-mode ultrasound could be clinically applied to identify structural change in the diabetic foot and be utilised as an early predictor of ulceration risk.MethodsPrimary databases and grey literature sources were systematically searched. Selection criteria were that the study included a diabetic sample and used B-mode ultrasound to assess soft tissue structures of the foot (plantar skin, plantar fat pad or intrinsic muscles).ResultsFifteen studies were identified for inclusion (combined diabetic sample of 773). Ultrasound demonstrated reductions in tissue thickness in diabetics compared to non-diabetics under first (p = 0.01) and second (p = 0.03) metatarsal heads, but not the third (p = 0.24). Statistical heterogeneity was high for ultrasound thickness measures under metatarsal heads four/five (I2 65%, 81%) and very high for plantar skin (I2 98%), heel pad (I2 76%) and intrinsic muscles (I2 91%, 81%). Extensor digitorum brevis (EDB) ultrasound measures were significantly thinner in diabetics for all dimension measures compared to healthy controls except one study, which reported no significant differences in EDB thickness.ConclusionsNo direct evidence was found to indicate B-mode ultrasound measures can predict soft tissue changes in the plantar foot in diabetes, although low level studies indicate ultrasound has the potential to identify structural change. Clinical, methodological and statistical heterogeneity limit result applicability. This review highlights the need for robust prospective longitudinal research to examine the predictive validity of this method.

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“…23 On the other hand, in diabetics, an increased thickness of the tendons and plantar structures was found, related to the increase in proteins of the cutaneous structures. 24 The complete absence of venous disease allowed us to exclude the impact of subcutaneous oedema in clinical findings. Our findings do not confirm the association between those two separate mechanisms in obese patients, in whom the mechanical components seem to play a major role.…”

Section: Discussionmentioning

confidence: 99%

<p>Using Skin Bioengineering to Highlight How Weight and Diabetes Mellitus Modify the Skin in the Lower Limbs of Super-Obese Patients</p>

Iacopi¹,

Riitano²,

Dini³

et al. 2020

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Aim: To evaluate the distinct contribution of obesity and diabetes (DM) to the skin modification in metabolic diseases. Methods: We analysed all patients admitted for bariatric surgery in our hospital with BMI between 38 and 47 kg/m 2 , with (Group 1) or without (Group 2) DM and compared them with a group of nonobese diabetic patients (Group 3) and healthy volunteers (Group 4). The following features were evaluated: hardness, temperature, hydration and thickness alongside with anthropometric measures of foot and leg.

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Intrinsic foot muscle and plantar tissue changes in type 2 diabetes mellitus

Cited by 30 publications

References 19 publications

Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis

Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis

Can ultrasound measures of intrinsic foot muscles and plantar soft tissues predict future diabetes-related foot disease? A systematic review

<p>Using Skin Bioengineering to Highlight How Weight and Diabetes Mellitus Modify the Skin in the Lower Limbs of Super-Obese Patients</p>

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