A Review of the Biomechanics of the Diabetic Foot

Abstract

In general, diabetic foot ulcers result from abnormal mechanical loading of the foot, such as repetitive moderate pressure applied to the plantar aspect of the foot while walking. Diabetic peripheral neuropathy causes changes in foot structure, affecting foot function and subsequently leading to increased plantar foot pressure, which is a predictive risk factor for the development of diabetic foot ulceration. Prevention of diabetic foot ulceration is possible by early identification of the insensitive foot, therefore a foot "at risk," and by protecting the foot from abnormal biomechanical loading. Abnormal foot pressures can be reduced using several different approaches, including callus debridement, prescription of special footwear, injection of liquid silicone, Achilles tendon lengthening, and so forth. Off-loading of the diabetic wound is a key factor in successful wound healing, as it is associated with reduced inflammatory and accelerated repair processes. Pressure relief can be achieved using various off-loading modalities including accommodative dressing, walking splints, ankle-foot orthosis, total contact cast, and removable and irremovable cast walkers.

Análise do equilíbrio postural de indivíduos diabéticos por meio de baropodometria

“…A neuropatia diabética periférica (NDP), com uma incidência de 50 a 80%, dependendo do critério de avaliação utilizado (Bacarin, Sacco, & Hennig, 2009;Tapp et al, 2003;), parece surgir primariamente, como um distúrbio sensorial, causando perda gradual da sensibilidade à dor, da percepção da pressão plantar, temperatura e propriocepção e, posteriormente, como um distúrbio motor. Este último contribuindo para atrofia e fraqueza muscular, deformidades ósseas, desequilíbrio da mecânica do pé, déficit de equilíbrio, dificuldade para deambular e risco a quedas (Sacco, Noguera, Bacarin, Casarotto, & Tozzi, 2009;Van Schie, 2005).…”

Contribuições da biomecânica para o estudo da neuropatia diabética e suas consequências para o movimento plantar

“…These results suggested that diabetic neuropathic subjects with metatarsal head deformities adopt a strategy while walking to reduce plantar loads at the anterior parts of the foot that are structurally altered. These anterior areas of the plantar surface present more risk of ulcer formation than other areas 20,25,27 .…”

“…Larger anterior contact area, higher posterior loads, and lesser loads at the metatarsal heads may be a result of an alteration of foot rollover mechanics from the heel rocker action at the initial contact to the propulsion by the forefoot rocker 27 . Neuropathic diabetic subjects may experience neuropathy pain during walking, and the metatarsal head prominences may worsen their symptoms.…”

“…Subjects walked on a 10 meter walkway at a self-selected speed while wearing only Pedar-X insoles from Novel ® System (Munich, Germany) inside anti-skid socks, as described in the literature 27 . The insoles were 2.5 mm thick and contained a matrix of 99 capacitive pressure sensors with a spatial resolution of 1.6 to 2.2 cm 2 .…”

Avaliação do impacto clínico e da viabilidade econômica da implantação de um modelo de Atenção Farmacêutica em uma Unidade Básica Distrital de Saúde de Ribeirão Preto - SP

“…Pacientes diabéticos que apresentam insensibilidade, fraqueza muscular e diminuição da amplitude do movimento, têm maior risco para o desenvolvimento de ulcerações nos pés (SCHIE, 2005). O pé diabético representa uma das complicações mais mutilantes de grande impacto social e econômico (SBD, 2006;ADA, 2004a), sendo responsável por cerca de 50% das amputações dos membros inferiores nos EUA (HUMPHREY et al, 1994).…”