Bone structure abnormalities and impaired foot and ankle biomechanics in diabetic patients are key risk factors for development of serious ulcers. That, according to research reported in the current issue of the Journal of Foot and Ankle Surgery.
The study’s lead author, Troy J. Boffeli, DPM, FACFAS, chief of podiatry services, Regions Hospital, St. Paul, Minnesota, said that diabetic patients with neuropathy, a common complication of the disease which causes loss of sensation in the feet, should be screened for certain biomechanical problems, such as limited ankle and big-toe mobility.
Identifying and monitoring diabetes patients with pre-existing foot problems early in the course of the disease could improve the success of treatment for foot ulcers and lower the incidence of recurrence, infection and amputation. "The study demonstrates the importance of recognizing biomechanical and structural abnormalities that make diabetic patients more susceptible to ulcerations," said Boffeli.
He added that structural and biomechanical problems often are overlooked when healthcare providers treat patients with diabetes. "The more immediate concerns about infection, poor circulation and wound dressings overshadow the underlying cause of many of these wounds," said Boffeli. "While neuropathy also is a concern, it is irreversible. Therefore, the structural and biomechanical abnormalities must be addressed to heal the wound and prevent recurrence."
Bofelli said those with diabetic neuropathy and biomechanical problems should wear custom shoes or orthotic inserts as prescribed by a podiatric foot and ankle surgeon to reduce pressure. In some cases, however, surgery might be required to prevent or heal ulcers.