The aetiology of diabetic neuropathic ulceration of the foot

Delbridge, Leigh; Ctercteko, Grahame; Fowler, Clare J.; Reeve, T. S.; Quesne, L. P. Le

doi:10.1002/bjs.1800720102

Cited by 139 publications

(48 citation statements)

References 56 publications

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“…The authors showed that the resting oxygen saturation averaged over the area surrounding the ulcer was lower among diabetic subjects with neuropathy than among both diabetic subjects without neuropathy and nondiabetic subjects. This suggests that diabetic neuropathy, which is a major contributor to ulceration, 10,11 could be detected by hyperspectral tissue oximetry.…”

Section: Hyperspectral Imaging For Diabetic Foot Wound Carementioning

confidence: 97%

Hyperspectral Imaging in Diabetic Foot Wound Care

Yudovsky

Nouvong

Pilon

2010

J Diabetes Sci Technol

138

109

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Diabetic foot ulceration is a major complication of diabetes and afflicts as many as 15 to 25% of type 1 and 2 diabetes patients during their lifetime. If untreated, diabetic foot ulcers may become infected and require total or partial amputation of the affected limb. Early identification of tissue at risk of ulcerating could enable proper preventive care, thereby reducing the incidence of foot ulceration. Furthermore, noninvasive assessment of tissue viability around already formed ulcers could inform the diabetes caregiver about the severity of the wound and help assess the need for amputation. This article reviews how hyperspectral imaging between 450 and 700 nm can be used to assess the risk of diabetic foot ulcer development and to predict the likelihood of healing noninvasively. Two methods are described to analyze the in vivo hyperspectral measurements. The first method is based on the modified Beer-Lambert law and produces a map of oxyhemoglobin and deoxyhemoglobin concentrations in the dermis of the foot. The second is based on a two-layer optical model of skin and can retrieve not only oxyhemoglobin and deoxyhemoglobin concentrations but also epidermal thickness and melanin concentration along with skin scattering properties. It can detect changes in the diabetic foot and help predict and understand ulceration mechanisms

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Section: Hyperspectral Imaging For Diabetic Foot Wound Carementioning

confidence: 97%

Hyperspectral Imaging in Diabetic Foot Wound Care

Yudovsky

Nouvong

Pilon

2010

J Diabetes Sci Technol

138

109

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“…demonstrated that the keratin in the stratum corneum of the foot is glycosylated in comparison to the skin of the nondiabetic. Both collagen and keratin are known to become stiffer when glycosylated (Brownlee et al 1984, Delbridge andCtercteko 1985) and this is probably detrimental to the mechanical properties of the skin. Metabolic changes may also affect the healing rate of ulceration.…”

Section: Plantar Soft Tissue Changes In the Diabetic Footmentioning

confidence: 99%

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

Cobb¹,

Claremont²

2001

Medical Engineering & Physics

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An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot. Jonathan Edwin CobbPlantar ulceration is a complication of the diabetic foot prevalent in adults with type 11 diabetes mellitus. Although neuropathy, microvascular disease and biornechanical factors are all implicated, the mechanism by which the tissue becomes pre-disposed to damage remains unclear. Recent theories suggest that the nutritional supply to the tissue is compromised, either by increased flow through the arteriovenous anastomoses ('capillary steal' theory) or through changes in the micro vascu I ature (haemodynamic hypothesis). Clinical data to support these ideas has been limited to assessment of the unclad foot under rest conditions. A limitation of previous studies has been the exclusion of static and dynamic tissue loading, despite extensive evidence that these biornechanical factors are essential in the development of plantar ulceration. The present study has overcome these problems by allowing assessment of plantar blood flow, in-shoe, during standing and walking.The system comprises a laser Doppler blood flux sensor operating at 780nm, load sensor, measurement shoe, instrumentation, and analysis software. In-vitro calibration was performed using standard techniques. An in-vivo study of a small group of diabetic subjects indicated differences in the blood flux response between diabetic neuropaths, diabetics with vascular complications and a control group. For example, following a loading period of 120s, relative increases in response from rest to peak were: Control (150% to 259%), Vascular (-70% to 242%), Neuropathic (109%-174%) and recovery times to 50% of the peak response were: Control (33s to 45s), Vascular (43s to >120s), Neuropathic (>120s). Dynamic re-perfusion rates (arbitrary units per millisecond) obtained for the swing phase of gait were: Control (6.1 a. u/ms to 7.9 a. u/ms), Vascular (4 a. u/ms to 6.2 a. u/ms), Neuropathic (2.3 a. u/ms to 4.5 a. u/ms).

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“…n diabetic patients, peripheral neuropathy induces foot deformities and changes in the walking pattern that are responsible for the development of areas of high plantar pressure (1)(2)(3).…”

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confidence: 99%

Contribution of Plantar Fascia to the Increased Forefoot Pressures in Diabetic Patients

et al. 2003

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OBJECTIVES -Secondary to peripheral neuropathy, plantar hyperpressure is a proven risk factor for foot ulceration. But limited joint mobility (LJM) and soft tissue abnormalities may also contribute. The aim of this study was to evaluate the relationships among thickness of plantar fascia, mobility of the metatarso-phalangeal joint, and forces expressed under the metatarsal heads.RESEARCH DESIGN AND METHODS -We evaluated 61 diabetic patients: 27 without neuropathy (D group), 19 with neuropathy (DN group), and 15 with previous neuropathic foot ulceration (DNPU group). We also examined 21 control subjects (C). Ultrasound evaluation was performed with a high resolution 8-to 10-MHz linear array (Toshiba Tosbee SSA 240). The foot loading pattern was evaluated with a piezo-dynamometric platform. First metatarsophalangeal joint mobility was assessed with a mechanic goniometer.RESULTS -Diabetic patients presented increased thickness of plantar fascia (D 2.9 Ϯ 1.2 mm, DN 3.0 Ϯ 0.8 mm, DNPU 3.1 Ϯ 1.0 mm, and C 2.0 Ϯ 0.5.mm; P Ͻ 0.05), and significantly reduced motion range at the metatarso-phalangeal joint (D 54.0 Ϯ 29.4°, DN 54.9 Ϯ 17.2°, DNPU 46.8 Ϯ 20.7°, and C 100.0 Ϯ 10.0°; P Ͻ 0.05). The evaluation of foot-floor interaction under the metatarsal heads showed increased vertical forces in DN and DNPU and increased medio-lateral forces in DNPU. An inverse correlation was found between the thickness of plantar fascia and metatarso-phalangeal joint mobility (r ϭ Ϫ0.53). The thickness of plantar fascia was directly correlated with vertical forces under the metatarsal heads (r ϭ 0.52).CONCLUSIONS -In diabetic patients, soft tissue involvement may contribute to the increase of vertical forces under the metatarsal heads. Changes in the structure of plantar fascia may also influence the mobility of the first metatarso-phalangeal joint. Diabetes Care 26:1525-1529, 2003I n diabetic patients, peripheral neuropathy induces foot deformities and changes in the walking pattern that are responsible for the development of areas of high plantar pressure (1-3).Mechanical stress has been recognized to have a central pathogenic role in the onset of diabetic neuropathic ulcers (4). Among the factors that may contribute to increase mechanical stress, limited joint mobility (LJM) of the ankle joint is associated with increased peak forefoot pressures, and therefore with risk of ulceration (5,6). Atrophy and weakness of tibialis anterior and vastus lateralis muscles as well as atrophy of the intrinsic muscles have been recognized to induce important changes in the performance of the ankle movements and in the biomechanical properties of the diabetic neuropathic foot (3). Another well-known cause of increased forefoot pressure is the increased thickness of the Achilles tendon; the efficacy of its surgical lengthening on forefoot pressure release has been investigated and reported in literature, even if the results still show some discrepancies (7,8). Structural changes in the forefoot of diabetic neuropathic patients, in terms of bone and muscle...

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The aetiology of diabetic neuropathic ulceration of the foot

Cited by 139 publications

References 56 publications

Hyperspectral Imaging in Diabetic Foot Wound Care

Hyperspectral Imaging in Diabetic Foot Wound Care

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

Contribution of Plantar Fascia to the Increased Forefoot Pressures in Diabetic Patients

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