Foot biomechanics in patients with diabetes mellitus: doubts regarding the relationship between neuropathy, foot motion, and deformities.

BACKGROUND: We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities. METHODS: This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed. RESULTS: No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039). CONCLUSIONS: Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors.

[Reducing skin maceration in exudative diabetic foot ulcers]. / Reducir la maceración de úlceras exudativas del pie diabético.

INTRODUCTION: highly exudate and maceration is one of the causes of delay in diabetic foot ulcers healing. The purpose of our study was to demonstrate the effectiveness in the periwound skin maceration reduction with the use of no-sting barrier film (NSBF) (3M Cavilon). MATERIAL AND METHODS: observational study which includes 40 patients with diabetes (29, 72.5% males) who suffer diabetic foot ulcers with maceration and exudate. It was evaluated the application of NSBF during 30 days and its correlation with maceration control and clinical wounds progress. RESULTS: 70% of the ulcers were showed healthy edge or lower exudates after 30 days of treatment (Day 0 n=8 vs Day 30 n=28 p<0.05). Good evolutions of clinical variables were recorded through the study. Fibrin tissues upper 60% of the ulcer area were recorded in 17 cases at day 0 versus 2 cases in day 30 (p<0.001). Granulation tissue presence turned of 13 cases with upper 50% in wound bed at day 0 versus 25 cases at the end of the study (p<0.001). DISCUSSION: the use of NSBF for the maceration management of highly exudates diabetic foot ulcers was demonstrated effective.

[Randomized comparative trial of a collagen/oxidized regenerated cellulose dressing in the treatment of neuropathic diabetic foot ulcers]. / Estudio aleatorizado y comparativo de un apósito de colágeno y celulosa oxidada regenerada en el tratamiento de úlceras neuropáticas de pie diabético.

INTRODUCTION: Diabetic foot is a complication of diabetes mellitus that manifests with the development of ulcers that frequently precede amputation. Several studies have verified that the environment of the diabetic neuropathic foot ulcer contains a high concentration of metalloproteinases. The aim of the present study was to evaluate the efficacy of a protease-modulating dressing in the treatment of neuropathic diabetic foot ulcers. MATERIAL AND METHOD: A randomized controlled trial was conducted in 40 patients with a 6-week or longer history of neuropathic diabetic foot ulcer. The patients were randomized to two groups: group 1 (n = 20) received treatment with the protease-modulating dressing while the control group (group 2; n = 20) received the treatment specified in the standardized protocol for good wound care. The patients were then followed-up for 6 weeks. RESULTS: After 6 weeks, healing was achieved in 12 patients (63% of n = 19) in group 1 under treatment with the protease-modulating dressing versus three patients (15% of n = 19) in the control group (p < 0.03). The mean time to healing was 23.3 +/- 9.9 days in group 1 and 40.6 +/- 1.15 days in group 2 (p < 0.01). CONCLUSIONS: The results confirm the hypothesis that the use of protease-modulating dressings in patients with neuropathic diabetic foot ulcers leads to better tissue regeneration than good wound care.