Biomechanics In Diabetic Foot

Introduction In order to understand why biomechanics plays a significant role in the management of the diabetic foot one needs to understand what the diabetic foot is. The diabetic foot is often referred to as an at risk foot.3This is due to the various complications that can arise within in a diabetic foot. These complications are associated with the pathophysiological process that occurs in uncontrolled diabetes mellitus. In general complications seen in the diabetic foot are related to the inadequate supply of either the vascular system, neurological system or a combination of both systems.1 Figure 1 below explains how various predisposing factors interact

The neuroischemic foot results from atherosclerosis within the vessels of the leg or foot and the presence of neuropathy which leads to minor trauma.4 Charcot neuroarthropathy is a progressive condition of the musculoskeletal system that is characterized by joint dislocations, pathologic fractures, and debilitating deformities most commonly in the lower extremity.5 Its pathophysiology is related to two theories namely the neurotramatic or neuroischemic theories or a combination of both. The biggest concern in the diabetic foot is ulcer development. Management of diabetic patients is mainly aimed at preventing ulcer formation or controlling and promoting healing within existing ulcers.3 Figure 1 A diagram indicating how predisposing factors integrate.2 Figure 2 Leg abnormalities seen in diabetesBiomechanical aspects associated to the diabetic foot The underlying pathophysiology of diabetes mellitus is metabolic in nature however the diabetic foot is greatly impacted by biomechanics because generally injury isn’t a result of infection or inadequate vascular supply but rather results from mechanical stresses associated with neuropathy. The loss of sensation within the foot increases the risk of tissue injury associated to mechanical factors such as excessive pressure and increased friction

It protects the skin of the foot and offloads ulcers to insure healing occurs and prevents pressure being applied to the affected limb  Bivalved cast a removable cast that has an incision down the middle used to relive pressure but immobilise the foot  Windowed wound protection cast this is a TCC which has a cut over the wound that allows one to dress and treat the wound without removing the cast insuring immobilisation of the foot and promoting healing. Figure 4 various types of offloading devices4 Surgical management is needed when complications are server and conservative management is not adequate. Procedures that could be performed are listed below:3  Incision and drainage of infection- this is important when dealing with complicated wounds and promotes healing  Athroplasty-This is a regeneration of a joint to improve functionality. This procedure can be done by resurfacing bone or replacing the bone with prosthesis  Osteotamies – The removal of a wedge of bone resulting in the realignment of that bone  Amputations – The removal