Foot function and strength of patients with diabetes grouped by ulcer risk classification (IWGDF)

Jane S S P Ferreira; João P Panighel; Érica Q Silva; Renan L Monteiro; Ronaldo H Cruvinel Júnior; Isabel C N Sacco

doi:10.1186/s13098-019-0487-x

Foot function and strength of patients with diabetes grouped by ulcer risk classification (IWGDF)

Diabetol Metab Syndr. 2019 Oct 30:11:89. doi: 10.1186/s13098-019-0487-x. eCollection 2019.

Authors

Jane S S P Ferreira¹, João P Panighel¹, Érica Q Silva¹, Renan L Monteiro^{1

2}, Ronaldo H Cruvinel Júnior¹, Isabel C N Sacco¹

Affiliations

¹ 1Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, Rua Cipotânea, 51-Cidade Universitária, São Paulo, 05360-160 Brazil.
² 2Departamento de Ciências da Saúde, Universidade Federal do Amapá, Macapá, Amapá Brazil.

Abstract

Background: The stratification system from the International Working Group on the Diabetic Foot (IWGDF) was used to classify the participants as to the ulcer risk. However, it is not yet known what the classification groups' individual deficits are regarding sensitivity, function, and musculoskeletal properties and mechanics. This makes it difficult to design proper ulcer prevention strategies for patients. Thus, this study aimed to investigate the foot function, foot strength and health of people with diabetes mellitus (DM)-with or without DPN-while considering the different ulcer risk classifications determined by the IWGDF.

Methods: The subject pool comprised 72 people with DM, with and without DPN. The patients were divided into three groups: Group 0 (G0), which comprised diabetic patients without DPN; Group 1 (G1), which comprised patients with DPN; and Group 2 (G2), which comprised patients with DPN who had foot deformities. The health and foot function of the subjects' feet were assessed using a foot health status questionnaire (FHSQ-BR) that investigated four domains: foot pain, foot function, footwear, and general foot health. The patients' foot strength was evaluated using the maximum force under each subject's hallux and toes on a pressure platform (emed q-100, Novel, Munich, Germany).

Results: Moderate differences were found between G0 and G1 and G2 for the foot pain, foot function, general foot health, and footwear. There was also a small but significant difference between G0 and G2 in regards to hallux strength.

Conclusion: Foot health, foot function and strength levels of people with DM and DPN classified by the ulcer risk are different and this must be taken into account when evaluating and developing treatment strategies for these patients.

Keywords: Diabetic foot; Diabetic neuropathies; Muscle weakness; Ulcer.