The Neuropathic Ulcer and Loads on the Foot in Diabetic Patients

Stokes, Ian A. F.; Faris, Irwin; Hutton, W. C.

doi:10.3109/17453677508989271

Cited by 123 publications

(45 citation statements)

References 6 publications

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“…Sixth, measurements were made with the patients in bare feet. Even though we rarely walk barefoot, because there is such a wide variety of shoe wear and shoes alter the pedobarographic examination to such a degree that meaningful results cannot be measured, measurements frequently are made with the patient barefoot [2,6,14,16,19,20,26,28,40,41]. We cannot presume we would have the same findings were the patients wearing shoes.…”

Section: Discussionmentioning

confidence: 84%

“…This dynamic alignment can be measured by pedobarography, allowing measurement of pressure distribution of the foot during the rollover process [6,7,9,23,32]. Barefoot pedobarography has been used to observe correlation of foot pain and abnormally high pressure areas in clubfeet [6,14], to identify high pressure areas at risk for ulceration [2,16,41], and to investigate the mechanical change in patients with rheumatoid arthritis in the feet [28,40], metatarsalgia [19], hallux valgus [20], and cavovarus deformity [26].…”

Section: Introductionmentioning

confidence: 99%

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Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Frigg

Nigg

Davis

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The Saltzman-el-Khoury hindfoot alignment view (HAV) is considered the gold standard for assessing the axis from hindfoot to tibia. However, it is unclear whether radiographic alignment influences dynamic load distribution during gait. Questions/purposes We evaluated varus-valgus alignment by the HAV and its influence on dynamic load distribution in ankle and tibiotalocalcaneal (TTC) arthrodesis. Patients and Methods We clinically assessed 98 patients (ankle, 56; TTC, 42) with SF-36 and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual hindfoot alignment, HAV angle, and dynamic pedobarography using a five-step method. For comparison, 70 normal feet were evaluated. Minimum followup was 2 years (average, 4.11 years; range, 2-6 years). Results The mean HAV angle was À0.8°± 7.8°for ankle and À1.2°± 6.9°for TTC arthrodesis. The HAV angle correlated with pedobarographic load distribution (r = 0.35-0.53). Radiographic alignment did not influence SF-36 or AOFAS scores; however, load distribution correlated to qualities of these scores. Visual alignment only predicted the corresponding HAV angle in 48%. To reproduce the dynamic load of healthy subjects, HAV angles of 5°to 10°valgus were needed. Conclusions Visual positioning is inadequate to determine intraoperative positioning and resulted in a varus position with a relatively large SD. The HAV should be used to assess the hindfoot alignment correctly. HAV angles of 5°to 10°valgus are needed to reproduce a physiologic gait pattern.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Frigg

Nigg

Davis

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…A bnormal plantar pressures are considered the main cause of neuropathic foot ulceration (1)(2)(3)(4)(5). However, high pressures are only the last ring of a chain to which several factors contribute, including peripheral neuropathy and limited joint mobility.…”

Section: Diabetes Care 25:1451-1457 2002mentioning

confidence: 99%

Walking Strategy in Diabetic Patients With Peripheral Neuropathy

et al. 2002

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OBJECTIVE -Diabetic neuropathic patients show a peculiar loading pattern of the foot, which led us to hypothesize that a substantial modification exists in their deambulatory strategy. The aim of the present study was to support this hypothesis by quantifying the changes of the loading patterns and by monitoring the excursion of center of pressure (COP) during gait. RESEARCH DESIGN AND METHODS-A total of 21 healthy volunteers (C) and 61 diabetic patients were evaluated: 27 diabetic subjects without neuropathy (D), 19 with neuropathy (DN), and 15 with previous neuropathic ulcer (DPU). A piezo-dynamometric platform was used to record the foot-to-floor interaction by measuring loading time and the instantaneous COP position during the stance phase of gait.RESULTS -Loading time was significantly longer in neuropathic patients than in control subjects (DPU: 816.8 Ϯ 150 ms; DN: 828.6 Ϯ 152 ms; D: 766.5 Ϯ 89.9 ms; C: 723.7 Ϯ 65.7 ms; P Ͻ 0.05). COP excursion along the medio-lateral axis of the foot clearly decreased from C to DPU groups (C: 6.41 Ϯ 0.1 cm; D: 4.88 Ϯ 0.2 cm; DN: 4.57 Ϯ 0.1 cm; DPU: 3.36 Ϯ 0.1 cm; P Ͻ 0.05) as well as COP excursion along the longitudinal axis for the DPU group only (C: 26.6 Ϯ 1 cm; D: 26.9 Ϯ 1 cm; DN: 27.2 Ϯ 1 cm; DPU: 24.2 Ϯ 1 cm; P Ͻ 0.05). COP integrals were significantly reduced for all pathological classes (DPU: 14.2 Ϯ 8 cm 2 ; DN: 25.8 Ϯ 6 cm 2 ; D: 27.7 Ϯ 3 cm 2 ; C: 38.6 Ϯ 6 cm 2 ; P Ͻ 0.05).CONCLUSIONS -The accurate quantification of loading patterns and of COP excursions and integrals highlights changes of foot-to-floor interaction in diabetic neuropathic patients. The decreased medio-lateral and longitudinal COP excursions and corresponding changes of loading times and patterns support our hypothesis that a change in the walking strategy of diabetic patients with peripheral neuropathy does occur. Diabetes Care 25:1451-1457, 2002A bnormal plantar pressures are considered the main cause of neuropathic foot ulceration (1-5). However, high pressures are only the last ring of a chain to which several factors contribute, including peripheral neuropathy and limited joint mobility. It is worth emphasizing that those factors may influence not only the foot loading, but, more widely, the whole performance of the lower limb during gait.A few authors have suggested that patients with peripheral neuropathy develop a change in their walking strategy, shifting from an ankle to a hip strategy (6,7). In a recent article, our group also hypothesized this kind of change by analyzing the foot loading pattern (8). The aim of the present work was to further support this hypothesis by using a different parameter, namely the evolution of the center of pressure (COP) that is the point of application of the ground reaction force (GRF). COP records the succession of instantaneous positions during the entire period of contact between foot and floor and is plotted as a sequence of points on the ground plane. It takes into account the displacement of load throughout the foot during the stance phase of a wal...

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“…The presence of autonomic neuropathy may reduce the response to injury since the histamine induced triple response is reduced (Strokes et al and Faris). 12 Microangiopathy in muscles and skin, manifested by thickened basement membranes and endothelial proliferation in the arterioles and capillaries are now considered as contributory factors for the foot lesion as studies by Goldberg et al, Moore et al and Pederson. 13 Siperstein et al have suggested that may impede leucocyte migration from blood and impart adequate perfusion of nutrient and hormones at sites of bacterial invasion.…”

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confidence: 99%

Clinicopathological study of diabetic foot in Bundelkhand area with special reference to fungal infection in asymptomatic feet of diabetic patients

Mishra

Pratap

2017

Int Surg J

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Background: As with substantial increasing in incidence of diabetes mellitus in present century and with huge prevalence in population; the incidence of one of the dreadful complication of diabetes i.e. diabetic foot also increases, leading to increase morbidity and mortality. Fungal infection in foot is one of the underweighted cause of foot ulceration. These microulceration in conjunction with diabetes may leads to fulminant infection. The study comprised of 66 cases out of which 16 served as control. Aim and objectives of our study is to study the incidence of fungal infection in asymptomatic feet of diabetic patients, identification of the type of fungus, comparison with nondiabetics and clinicopathological study of the patients.Methods: The present study was carried at Department of Surgery, MLB. Medical College, Jhansi, the study group was classified into two groups. Control group; this group comprised of non-diabetic patients with foot lesions. Disease group; diabetic patients with foot lesions. Webs scrapings were inoculated in Sabouraud’s media slopes. Cultured media were examined after 3 days for the growth. Identification depends on colonial appearance and the morphology of the spores and by Gram, s and AFB Staining.Results: By this study we conclude that fungal infection in asymptomatic foot of diabetes patient are significantly more than non-diabetic patients which is accentuated by duration, type, glycaemic control and practice of bare foot walking which makes diabetic patient more prone for diabetic foot. So, the foot care of patients of diabetes should include the prophylactic steps to prevent fungal growth.Conclusions: By above study, we reasonably conclude that fungal infection in diabetic patients plays a pivotal role in formation of diabetic foot disease, so by eradication of fungal infection in asymptomatic foot of diabetic patient by general preventive methods and/or pharmacological methods may be beneficial in reducing morbidity and mortality in diabetic foot patients.

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The Neuropathic Ulcer and Loads on the Foot in Diabetic Patients

Cited by 123 publications

References 6 publications

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Walking Strategy in Diabetic Patients With Peripheral Neuropathy

Clinicopathological study of diabetic foot in Bundelkhand area with special reference to fungal infection in asymptomatic feet of diabetic patients

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