Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity

Bus, Sicco A.; Maas, Mario; Lange, Antony de; Michels, R. P. J.; Levi, Marcel

doi:10.1016/j.jbiomech.2004.07.034

Cited by 146 publications

(88 citation statements)

References 30 publications

(44 reference statements)

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“…Prevalence of clawing or hammering toes in persons with DM has been reported to be 32 to 46% (Holewski et al, 1989;Smith et al, 1997). Hammer toe is an important predictor of plantar pressure and claw/hammer toe deformity is associated with elevated plantar pressures at the MTHs (Bus et al, 2005). Intrinsic foot muscle weakness has long been thought to be a proximate cause of deformity in the diabetic foot (Reiber et al, 1999).…”

Section: Diabetic Polyneuropathy and Ulcerationmentioning

confidence: 99%

Diabetic foot ulceration and amputation

Burns¹,

Jan²

2012

Rehabilitation Medicine

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Section: Diabetic Polyneuropathy and Ulcerationmentioning

confidence: 99%

Diabetic foot ulceration and amputation

Burns¹,

Jan²

2012

Rehabilitation Medicine

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“…In terms of pressure distribution, Bus et al [17] demonstrated that peak pressure of diabetic feet was more than 600kPa in a specific MTH area; meanwhile Bus et al [18] also recommended that mean pressure 100kPa or peak pressure 200kPa shall be selected as target for pressure relieving. So in our study, we set two numbers as criterion: one is the 100% of healthy counterpart; another is the 120% of diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Classification of Diabetic Feet in Terms of Risk of Ulceration

Hu¹,

Su²,

Xu³

et al. 2017

LFJ

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ABSTRACT. Diabetic feet are common complications in diabetes mellitus, but its classification in terms of risk of ulcer based on multiple measures was rear reported. Therefore the aim of this study was to establish a classification system for diabetic feet according to data from feet deformities, plantar pressures and peripheral neuropathy. This system comprised 13 categories with three main factors in varied levels: Feet deformities [Mild (one or without deformity), Moderate (two deformities) and Severe level (more than two deformities)], peripheral neuropathy (no, moderate and serious levels) and plantar pressure distribution (≤100%MP*; 100≤ and ≤120% MP*; more than 120% MP*, where "MP*" is the data of healthy population). Further, we conducted a case study to explain of our system, the results show that 32 patients with diabetes were divided into the following categories: 22 for I++, 8 for II+, 2 for IV+. Overall, This system can help the clinician detect the risk levels of feet and take necessary measures to prevent diabetic ulcers in feet.KEY WORDS: diabetic feet, feet ulcers, classification of diabetic feet, feet deformity, plantar pressure distribution CLASIFICAREA PICIORULUI DIABETIC ÎN FUNCŢIE DE RISCUL DE ULCERAŢIEREZUMAT. Piciorul diabetic reprezintă o complicaţie frecventă a diabetului zaharat, însă rareori s-a raportat clasificarea acestuia în ceea ce priveşte riscul de ulceraţie pe baza mai multor măsurători. Prin urmare, scopul acestui studiu a fost de a stabili un sistem de clasificare pentru piciorul diabetic, în funcţie de datele privind deformarea picioarelor, presiunea plantară şi neuropatia periferică. Acest sistem a cuprins 13 categorii cu trei factori principali pe diverse niveluri: deformări ale picioarelor [uşoare (o singură deformare sau fără deformare), moderate (două deformări) şi severe (mai mult de două deformări)], neuropatie periferică (lipsa acesteia, nivel moderat şi nivel mare) şi distribuţia presiunii plantare (≤100% MP*; 100≤ şi ≤120% MP*; peste 120% MP*, unde "MP*" reprezintă datele populaţiei sănătoase). Mai mult, s-a realizat un studiu de caz pentru a explica sistemul dezvoltat, iar rezultatele arată că 32 de pacienţi cu diabet au fost împărţiţi în următoarele categorii: 22 în categoria I++; 8 în categoria II+; 2 în categoria IV+. În ansamblu, acest sistem poate ajuta clinicianul să detecteze nivelurile de risc ale picioarelor şi să ia măsurile necesare pentru prevenirea ulceraţiilor asociate cu piciorul diabetic.CUVINTE CHEIE: picior diabetic, ulceraţii la nivelul picioarelor, clasificarea piciorului diabetic, deformarea picioarelor, distribuţia presiunii plantare CLASSIFICATION DES PIEDS DIABÉTIQUES SELON LE RISQUE D'ULCÉRATIONRÉSUMÉ. Le pied diabétique est une complication fréquente dans le diabète sucré, mais sa classification selon le risque d'ulcération à partir des mesures multiples a été signalée rarement. Par conséquent, l'objectif de cette étude a été d'établir un système de classification pour le pied diabétique selon les données sur les déformations des pieds, ...

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“…The ICCs for these variables were high (Ͼ0.98), which demonstrates that these variables can be assessed in a reproducible way. Small limits of agreement are important for regression analyses or correlation coefficients computed between variables of foot structure and/or foot function (3,5,6,15,16) because the outcomes from these analyses are determined by the scatter of individual cases.…”

Section: Discussionmentioning

confidence: 99%

Reproducibility of foot structure measurements in neuropathic diabetic patients using magnetic resonance imaging

Bus

Maas

Lindeboom

2006

Magnetic Resonance Imaging

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Purpose:To assess the intra-and interobserver agreement of commonly reported foot structure measurements in diabetic patients with neuropathy using magnetic resonance imaging (MRI). Materials and Methods:In 23 neuropathic diabetic patients and five age-matched healthy controls, sagittal-plane MR images of the forefoot were obtained to assess joint configuration and plantar fat-pad thickness on two different occasions by the same observer and once by a different observer. The degree of intrinsic muscle atrophy was scored from coronal plane images on two different occasions by two observers. Results:The intraclass correlation coefficients (ICCs) between occasions and between observers were Ͼ0.94. The mean differences (bias) and the limits of agreement (LoA ϭ mean Ϯ 2 SDs) were small for the metatarsal-phalangeal (MTP) joint angle, toe angle, and plantar fat-pad thickness (bias Յ 0.8°or 0.2 mm, LoA Յ 3.8°or 0.8 mm), but larger for interphalangeal joint angles (bias Յ 3.4°, LoA Յ 8.8°). The weighted kappa for intrinsic muscle atrophy was 0.94. Conclusion:Static foot structure data can be assessed reliably using MRI. Because changes in foot structure contribute to the development of foot ulcers in neuropathic patients, MRI may be a useful technique to assess risk of ulceration in these patients. DIABETIC FOOT ULCERATION is a frequently reported and serious complication in people with diabetes and peripheral neuropathy, and precedes the vast majority (85%) of lower-extremity amputations (1). Elevated dynamic plantar pressure has been established as a major risk factor for plantar ulceration in the diabetic foot with lack of protective sensation (2).Structural changes and deformities of the foot, such as claw/hammer toe deformity and thinning of soft tissue or fat pads underneath the metatarsal heads, are associated with increased plantar pressures in diabetic subjects (3-6). Additionally, intrinsic muscle atrophy secondary to peripheral neuropathy may significantly affect foot function and lead to altered gait biomechanics (7).Because of its multiplanar imaging capability and inherent superiority in tissue contrast, magnetic resonance imaging (MRI) is increasingly being used as a tool to assess structural pathology in the foot or lower leg of diabetic patients with peripheral neuropathy (5,7-11). These assessments are considered important for improving our understanding of the relationship between structure and function in the foot and the pathogenesis of foot ulceration.However, little is known about the reproducibility of the MRI assessments for this purpose. Therefore, the purpose of this study was to evaluate the intra-and interobserver agreement of (semi-)quantitative measurements by MRI of foot structure in neuropathic diabetic patients. MATERIALS AND METHODS SubjectsTwenty-eight subjects participated in this study and underwent MRI of the foot. The study group consisted of 23 diabetic patients with peripheral sensory neuropathy (15 men and eight women, mean age ϭ 56.8 years) and five age-matched healthy subject...

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Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity

Cited by 146 publications

References 30 publications

Diabetic foot ulceration and amputation

Diabetic foot ulceration and amputation

Classification of Diabetic Feet in Terms of Risk of Ulceration

Reproducibility of foot structure measurements in neuropathic diabetic patients using magnetic resonance imaging

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