Morphological Changes in Diabetic Foot

Abstract

Objective: Diabetic feet and toe deformities is commonly associated with diabetes mellitus and neuropathy is the causative factor combined with vasculopathy. In this study we list out various morphological changes which occur in Diabetic foot lesions, the pathophysiology and the management of the deformed toes and feet. Materials and Methods:A prospective study was carried out in patients presenting to the Diabetic Clinic at a tertiary care hospital in Delhi. 70 patients who were labelled as diabetics formed the study group. Results:The most common age group affected belonged to 51-60 age bracket which included 41 patients (58.5%). The male to female ratio was approximately 3:1. Majority of patients 32 (45.71%) had diabetes of >10 years duration. Foot and toe deformities affected majorly diabetics with moderately controlled diabetes mellitus and the study revealed that 40 patients (57.2%) had moderately controlled diabetes with blood sugar levels ranging from 160-200 mg/dl. The highest number of patients i.e. 29 patients (41.4%) who had foot/ toe deformities were on oral hypoglycaemic agents. Clawing of the toes (26 patients, 37.14% of patients), was the commonest morphological change in the architecture of the foot followed by Varus deformities (17 patients, 24.28% of patients). Nail changes in the form of hypertrophied and brittle nails affected 37 patients (52.85%). Conclusion:We concluded that team approach, adequate diabetic control combined with patient education about foot care and footwear will help prevent complications and improved quality of life of the patients suffering from diabetic foot and toe deformities.

An exploratory study of dynamic foot shape measurements with 4D scanning system

“…The forefoot seems more pointed since the toe angles increase during walking, especially at final push stances. The deformation of TA1 is slightly higher than TA5, which can be attributed to the fact that Hallux Valgus is commonly found in the feet of diabetic patients 66 . However, for shoe/insole design, pointed forefoot contour is not recommended due to toes spread out during standing.…”

Prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, 2022

“…This might be due to hyperglycemia that affects the nerves and microvasculature of the foot and the integrity of foot arches. Since muscles, ligaments, and connective tissue protect the integrity of the foot's arch [44], when motor neuropathy strikes, the muscles deteriorate and atrophy [6]. Due to the absence of the usual balance between the toe flexors and extensor muscles, a person may acquire foot deformities [44].…”

Prevalence and associated factors of foot deformity among adult diabetic patients on follow-up at Debre Markos comprehensive specialized hospital, Northwest Ethiopia, 2022, cross-sectional study

“…This might be due to hyperglycemia that affects the nerves and microvasculature of the foot and the integrity of foot arches. Since muscles, ligaments, and connective tissue protect the integrity of the foot’s arch [ 53 ], when motor neuropathy strikes, the muscles deteriorate and atrophy [ 6 ]. Due to the absence of the usual balance between the toe flexors and extensor muscles, a person may acquire foot deformities [ 53 ].…”

“…Since muscles, ligaments, and connective tissue protect the integrity of the foot’s arch [ 53 ], when motor neuropathy strikes, the muscles deteriorate and atrophy [ 6 ]. Due to the absence of the usual balance between the toe flexors and extensor muscles, a person may acquire foot deformities [ 53 ]. Similar to this, motor neuropathy typically exhibits structural changes to the dynamic anatomy of the foot and joints, leading to the wasting and weakness of small intrinsic muscles.…”