Foot deformities within the diabetic foot and their influence on biomechanics: A review of the literature

Abstract

Background: Diabetes mellitus causes a multitude of complications. Foot ulceration is one complication with serious consequences, amputation. Foot deformities contribute to ulcer development. It would be advantageous to ascertain whether foot deformities are preventable as their presence increases amputation risk.

Objectives: The objectives were to understand the development of foot deformities in diabetes and explore their biomechanical effects.

Study design: Literature review.

Methods: In February 2014 CINAHL, Embase, Ovid and Medline were searched. Studies in English of adults with Diabetes that reported neuropathy, foot deformities or associated gait abnormalities were included for review. All study designs were considered. The articles' quality was considered high overall, assessed using SIGN and CARS.

Results: In total, 17 studies were reviewed. The main themes identified in relation to foot deformities were nerve function, intrinsic foot muscles, muscle weakness and limited joint mobility. Nerve function and intrinsic foot muscle atrophy did not display definitive associations with foot deformities. However, muscle weakness and limited joint mobility were associated with foot deformities, although the relationship is still unclear.

Conclusion: The development of common foot deformities in diabetes is not well understood. The literature did not support the common belief that motor neuropathy, atrophy and muscle imbalance cause foot deformities.

Clinical relevance: An understanding of the aetiology of foot deformities in diabetes mellitus may allow for pro-active management of the foot in anticipation of the development of foot deformities and ulceration. If the aetiology of deformity was established preventative treatment may reduce the incidence of foot deformities and resultant ulcerations and amputations.

Keywords: Diabetes Mellitus; biomechanics; deformities; foot.