Diabetic Foot Essay

The diabetic foot is a notorious condition that podiatrists treat frequently. Multi-factorial in its development, the diabetic foot is a complex complication of diabetes mellitus1. Characteristically, the condition results in an increase in pressures acting on the plantar aspect of the foot, resulting in tissue destruction1. Alterations in anatomical structures force the foot to adapt in order to maintain some function, and in doing so, alters the biomechanics of the lower limb1. Pathological changes become increasingly prevalent and prevention of tissue destruction becomes exceedingly difficult1. Typically, treatment of the diabetic foot is conservative management involving offloading, however, surgical intervention is enlisted in order to

Studies have shown that loss of peripheral sensation increases the formation of anhidrotic and hyperkeratotic tissue1. Several studies have established a relationship between dry skin and ulceration1. Hyperkeratosis is associated with altered pressure distribution, higher shear stresses, and loss of skin elasticity1. All three are risk factors for ulceration. Motor neuropathy atrophies intrinsic muscles of the foot and results in a variety of deformities such as hallux valgus, dropped metatarsal heads, and clawed or hammer

Sensory neuropathy causes a delay in the activation of the ankle and knee joints during gait due to the lack of afferent input signals6. Combined with hyperkeratosis, a thinned fat pad, and limited motion of the first MTPJ, this ultimately lead to reduction of shock absorption and loss of momentum during gait due to decreased function of the first rocker of the foot, also called the heel rocker6. Midstance is characterized by muscle weakness producing gait instability6. Neuropathy once again reduces the input of sensory signals whilst joint motion limitation obstructs functionality of the second rocker of the foot – the ankle rocker-, further reducing