The Development of Foot Deformities and Ulcers After Great Toe Amputation in Diabetes

Quebedeaux, Terri L.; Lavery, Lawrence A.; Lavery, David C.

doi:10.2337/diacare.19.2.165

Cited by 107 publications

(54 citation statements)

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“…Thus, any changes in the foot architecture are important reasons to properly secure and stabilize this affected part of the body. Amputation of a great toe and part of all of the first metatarsophalagal joints disrupts the integrity of the medial column of the foot and the arch collapses [16]. It seems to be a rationale for using shoes in case of foot pathology.…”

Section: Discussionmentioning

confidence: 99%

“…The research revealed that even a partial loss of the toes not only changes the anatomical structure of the foot but also modifies the gait pattern [9,23]. We need to bear in mind that the toes are a crucial element in increasing the weight-bearing area during walking [6], as well as the first metatarsophalangeal joint complex, an important component in both stance and propulsive phases of gait [16]. The risk of toe damage is involved in alpine climbers' activity.…”

Section: Introductionmentioning

confidence: 99%

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Kinematic gait analysis of a young man after amputation of the toes

Forczek

Ruchlewicz

Gawęda

2014

Biomedical Human Kinetics

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SummaryStudy aim: the foot is recognised as a "functional unit" with two important aims: to support body weight and to serve as a lever to propel the body forward. When it is impaired, the locomotor pattern has to adapt to compensate for the dysfunction. The purpose of this study was to investigate gait kinematics of a man after bilateral partial amputation of the toes. Material and methods: the subject of the study was a young man aged 30 years (body height and mass: 186 cm, 82 kg) who suffered a frostbite injury in the feet while climbing in the severe mountain conditions. After a few months of treatment, the necessary amputation occurred. Three-dimensional lower limb kinematics was collected from motion capture system (Vicon 250) and Golem marker set-up using 5 video-based cameras with infrared strobes. The subject performed over-ground walking at self-selected speed, first barefoot, then wearing athletic shoes. Results: the patient's results are the mean values of sixteen full gait cycles. The spatiotemporal parameters were lower during gait without shoes. In terms of the angular changes of the lower limb joints in sagittal plane, the analysis revealed similar functional patterns and typical trends in both recorded conditions. The differences, however, occurred in their amplitude. A larger range of motion was generally noted in shod conditions. The higher the joint was, the smaller the differences were. Conclusions: changes in gait due to the forefoot dysfunction may be stabilizing adaptations related to fear of falling. Footwear provided more stable conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Kinematic gait analysis of a young man after amputation of the toes

Forczek

Ruchlewicz

Gawęda

2014

Biomedical Human Kinetics

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“…A history of foot ulcer and amputation reflects the presence of underlying pathologic conditions not otherwise captured by the measurements made in this study and have been shown previously to be related to a higher risk of recurrent ulcers and amputations (13). Also, amputation may produce changes in gait and/or foot shape that increase the subsequent risk for foot ulcer (14). Sensory neuropathy has consistently been demonstrated to be associated with a higher risk of foot ulcer in prospective research as measured using the monofilament or other modalities (15)(16)(17)(18).…”

Section: Conclusion -We Found That Commonly Available Clinical Informentioning

confidence: 99%

Prediction of Diabetic Foot Ulcer Occurrence Using Commonly Available Clinical Information

et al. 2006

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OBJECTIVE -The ability of readily available clinical information to predict the occurrence of diabetic foot ulcer has not been extensively studied. We conducted a prospective study of the individual and combined effects of commonly available clinical information in the prediction of diabetic foot ulcer occurrence.RESEARCH DESIGN AND METHODS -We followed 1,285 diabetic veterans without foot ulcer for this outcome with annual clinical evaluations and quarterly mailed questionnaires to identify foot problems. At baseline we assessed age; race; weight; current smoking; diabetes duration and treatment; HbA 1c (A1C); visual acuity; history of laser photocoagulation treatment, foot ulcer, and amputation; foot shape; claudication; foot insensitivity to the 10-g monofilament; foot callus; pedal edema; hallux limitus; tinea pedis; and onychomycosis. Cox proportional hazards modeling was used with backwards stepwise elimination to develop a prediction model for the first foot ulcer occurrence after the baseline examination.RESULTS -At baseline, subjects were 62.4 years of age on average and 98% male. Mean follow-up duration was 3.38 years, during which time 216 foot ulcers occurred, for an incidence of 5.0/100 person-years. Significant predictors (P Յ 0.05) of foot ulcer in the final model (hazard ratio, 95% CI) included A1C (1.10, 1.06 -1.15), impaired vision (1.48, 1.00 -2.18), prior foot ulcer (2.18, 1.61-2.95), prior amputation (2.57, 1.60 -4.12), monofilament insensitivity (2.03, 1.50 -2.76), tinea pedis (0.73, 0.54 -0.98), and onychomycosis (1.58, 1.16 -2.16). Area under the receiver operating characteristic curve was 0.81 at 1 year and 0.76 at 5 years.CONCLUSIONS -Readily available clinical information has substantial predictive power for the development of diabetic foot ulcer and may help in accurately targeting persons at high risk of this outcome for preventive interventions. Diabetes Care 29:1202-1207, 2006D iabetic foot ulcer and amputation continue to cause considerable morbidity among persons with diabetes (1). Foot ulcer has been recognized as an important antecedent of lower extremity amputation in multiple studies (2,3). Progress has occurred in understanding the pathogenesis of these complications (4), and methods to assist in the prediction of these outcomes have also been developed using various modalities, including lower limb sensory testing (5), thermography (6), and assessment of peak plantar pressure (7). Some of these modalities are unavailable to the vast majority of primary care clinical practitioners who provide much of the preventive and acute care of persons with diabetes.Also, the use of multiple risk indicators in combination to assist in the future prediction of diabetes complications has not been thoroughly explored and reported in a manner that permits assessment of prediction accuracy.Given the need for a prediction model of diabetic foot ulcer that utilizes multiple risk indicators that would be available in all clinical encounters that take place between patients and primary care or n...

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“…Observational studies suggest that transfer ulcers may be more common when DFO is managed surgically as opposed to medically [60,61]. No studies specifically addressed aftercare issues in patients with osteomyelitis, as against all forms of diabetic foot ulceration.…”

Section: Aftercarementioning

confidence: 99%

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

Berendt

Peters

Баккер³

et al. 2008

Diabetes Metab. Res. Rev.

276

214

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SummaryThe International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006.The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations.The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae.We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited, and further research is urgently needed.

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The Development of Foot Deformities and Ulcers After Great Toe Amputation in Diabetes

Cited by 107 publications

References 1 publication

Kinematic gait analysis of a young man after amputation of the toes

Kinematic gait analysis of a young man after amputation of the toes

Prediction of Diabetic Foot Ulcer Occurrence Using Commonly Available Clinical Information

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

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