Skip to main content
SpringerLink
Log in

Foot Pressure Abnormalities, Radiographic, and Charcot Changes in the Diabetic Foot

  • Chapter
  • First Online:
Diabetic Foot Ulcer

  • 1021 Accesses

Abstract

Diabetes Mellitus (DM) has become one of the biggest healthcare challenges of the twenty-first century and it has become one of the major causes of morbidity and mortality across the world. According to the International Diabetic Federation, 425 million had diabetes in the year 2016 and by the year 2045, the number will escalate to 629 million [1]. One of the most common complications of diabetes is Diabetic Neuropathy. According to the American Diabetic Association diabetic neuropathy is “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes” ‘[2]. The prevalence of diabetic peripheral neuropathy ranges from 16% to 66% [3, 4]. While the incidence of amputation in diabetic patients is 10–20 times greater than in non-diabetic patients [5]. Diabetes Mellitus (DM) has become one of the major causes of morbidity and mortality across the world. Many factors were implicated in the development of Charcot foot such as soft tissue abnormality, abnormal mobility, diabetic peripheral neuropathy, abnormal plantar pressure, and altered gait pattern. A multitude of mechanisms for pathogenesis has been proposed like 1). lack of vaso-regulation resulting in a high flow state and opening of arteriovenous shunting due to underlying autonomic neuropathy, 2). Autonomic neuropathy contributes to local osteopenia by increasing the local blood flow, 3). Pain impairment in Charcot’s foot is associated with repeated injury, resulting in persistent proinflammatory conditions, contributing to chronic local osteolysis, 4). Binding of AGEs to their receptor (RAGE) prevents the differentiation of human mesenchymal stem cells. They induce apoptosis of osteoblast through the RANKL / NF-kβ pathway.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. IDF atlas (2017). Available from: http://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html

  2. American Diabetes Association (2007) Standards of medical care in diabetes—2007 [Position statement]. Diabetes Care 30:S4–S41

    Google Scholar 

  3. Boulton AJ, Vileikyte L, RagnarsonTennvall G et al (2005) The global burden of diabetic foot disease. Lancet 366:1719–1724. https://doi.org/10.1016/S0140-6736(05)67698-2

    Article  PubMed  Google Scholar 

  4. Boulton AJM, Armstrong DG, Albert SF et al (2008) Comprehensive foot examination and risk assessment. Diabetes Care 31:1679–1685. https://doi.org/10.2337/dc08-9021

    Article  PubMed  PubMed Central  Google Scholar 

  5. Moxey PW, Gogalniceanu P, Hinchliffe RJ et al (2011) Lower extremity amputations – a review of global variability in incidence. Diabet Med 28(10):1144–1153. https://doi.org/10.1111/j.1464-5491.2011.03279.x

    Article  CAS  PubMed  Google Scholar 

  6. van Deursen R (2004) Mechanical loading and off-loading of the plantar surface of the diabetic foot. Clin Infect Dis 39:S87–S91

    PubMed  Google Scholar 

  7. Cavanagh PR, Rodgers MM, Iiboshi A (1987) Pressure distribution under symptom-free feet during barefoot standing. Foot Ankle 5:262–276

    Google Scholar 

  8. Hotfiel T, Carl HD, Wendler F, Jendrissek A, Heiß R, Swoboda B (2017) Plantar pressures increase with raising body weight: a standardised approach with paired sample using neutral shoes. J Back Musculoskelet Rehabil 30(3):583–589

    CAS  PubMed  Google Scholar 

  9. Martinez-Nova A, Huerta JP, Sánchez-Rodriguez R (2008) Cadence, age, and weight as determinants of forefoot plantar pressures using the biofoot in-shoe system. J Am Podiatr Med Assoc 98(4):302–310

    PubMed  Google Scholar 

  10. Rao S, Saltzman C, Yack HJ (2006) Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy. Gait Posture 24(3):295–301

    PubMed  Google Scholar 

  11. Blanc Y, Balmer C, Landis T, Vingerhoets F (1999) Temporal parameters and patterns of the foot roll over during walking: normative data for healthy adults. Gait Posture 10:97–108

    CAS  PubMed  Google Scholar 

  12. Mueller MJ, Diamond JE, Delitto A, Sinacore DR (1989) Insensitivity, limited joint mobility, and plantar ulcers in patients with diabetes mellitus. Phys Ther 69:453–459

    CAS  PubMed  Google Scholar 

  13. Armstrong DG, Lavery LA (1998) Plantar pressures are higher in diabetic patients following partial foot amputation. Ostomy Wound Manage 44:30–32. 34, 36

    CAS  PubMed  Google Scholar 

  14. Stokes IA, Faris IB, Hutton WC (1975) The neuropathic ulcer and loads on the foot in diabetic patients. Acta Orthop Scand 46:839–847

    CAS  PubMed  Google Scholar 

  15. Barn R, Waaijman R, Nollet F, Woodburn J, Bus SA (2015) Predictors of barefoot plantar pressure during walking in patients with diabetes, peripheral neuropathy and a history of ulceration. PLoS One 10:e0117443

    PubMed  PubMed Central  Google Scholar 

  16. Ledoux WR, Shofer JB, Smith DG, Sullivan K, Hayes SG, Assal M, Reiber GE (2005) Relationship between foot type, foot deformity, and ulcer occurrence in the high-risk diabetic foot. J Rehabil Res Dev 42:665–672

    PubMed  Google Scholar 

  17. Yavuz M (2014) Plantar shear stress distributions in diabetic patients with and without neuropathy. Clin Biomech (Bristol, Avon) 29:223–229

    Google Scholar 

  18. Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJM (2003) Predictive value of foot pressure assessment as part of a population-based diabetes disease management program. Diabetes Care 26:1069–1073

    PubMed  Google Scholar 

  19. Barrett JP, Mooney V (1973) Neuropathy and diabetic pressure lesions. Orthop Clin North Am 4:43–47

    CAS  PubMed  Google Scholar 

  20. Ctercteko GC, Dhanendran M, Hutton WC, Le Quesne LP (1981) Vertical forces acting on the feet of diabetic patients with neuropathic ulceration. Br J Surg 68:608–614

    CAS  PubMed  Google Scholar 

  21. Root ML, Weed JH, Sgarlato TE, Bluth DR (1966) Axis of motion of the sub-talar joint. Am Pod Ass 56:149–155

    Google Scholar 

  22. Lnman VT (1976) The sub-talar joint. In: Lnman VT (ed) The joints of the ankle. Williams and Wilkins, Baltimore, pp 35–43

    Google Scholar 

  23. Delbridge L, Perry P, Marr S, Arnold N, Yue DK, Turtle JR, Reeve TS (1988) Limited joint mobility in the diabetic foot: relationship to neuropathic ulceration. Diabet Med 5:333–337

    CAS  PubMed  Google Scholar 

  24. Delbridge L, Ctercteko G, Fowler C, Reeve TS, LeQuesne LP (1985) The aetiology of neuropathic ulceration in the diabetic foot. Brit Surg 75:1–6

    Google Scholar 

  25. Gefen A, Megido-Ravid M, Azariah M, Itzchak Y, Arcan M (2001) Integration of plantar soft tissue stiffness measurements in routine MRI of the diabetic foot. Clin Biomech (Bristol, Avon) 16:921–925

    CAS  Google Scholar 

  26. Abouaesha F, van Schie CH, Griffths GD, Young RJ, Boulton AJ (2001) Plantar tissue thickness is related to peak plantar pressure in the high-risk diabetic foot. Diabetes Care 24:1270–1274

    CAS  PubMed  Google Scholar 

  27. Murray HJ, Young MJ, Hollis S, Boulton AJ (1996) The association between callus formation, high pressures, and neuropathy in diabetic foot ulceration. Diabet Med 13:979–982

    CAS  PubMed  Google Scholar 

  28. van Deursen RW, Sanchez MM, Derr JA, Becker MB, Ulbrecht JS, Cavanagh PR (2001) Vibration perception threshold testing in patients with diabetic neuropathy: ceiling effects and reliability. Diabet Med 18:469–475

    PubMed  Google Scholar 

  29. Brand PW (1983) The diabetic foot. In: Ellenberg M, Rifkin H (eds) Diabetes mellitus: theory and practice, 3rd edn. Medical Examination Publishing, New York, pp 829–849

    Google Scholar 

  30. Zhu H, Wertsch JJ, Harris GF, Lofisgaarden JD, Price MB (1991) Foot pressure distribution during walking and shuffling. Arch Phys Med Rehabll 72:390–397

    CAS  Google Scholar 

  31. Fernando ME, Crowther RG, Pappas E, Lazzarini PA, Cunningham M, Sangla KS, Buttner P, Golledge J (2014) Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies. PLoS One 9:e99050

    PubMed  PubMed Central  Google Scholar 

  32. Rosenbaum D, Hautmann S, Gold M, Claes L (1994) Effects of walking speed on plantar pressure patterns and hindfoot angular motion. Gait Posture 2:191–197

    Google Scholar 

  33. Fernando M, Crowther R, Lazzarini P, Sangla K, Cunningham M, Buttner P, Golledge J (2013) Biomechanical characteristics of peripheral diabetic neuropathy: a systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure. Clin Biomech (Bristol, Avon) 28(8):831–845

    Google Scholar 

  34. Fernando ME, Crowther RG, Pappas E et al (2014) Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies. PLoS One 9(6):e99050

    PubMed  PubMed Central  Google Scholar 

  35. Couppé C, Svensson RB, Kongsgaard M et al (2016) Human Achilles tendon glycation and function in diabetes. J Appl Physiol 120(2):130–137

    PubMed  Google Scholar 

  36. Cavanagh PR, Sims DS Jr, Sanders LJ (1991) Body mass is a poor predictor of peak plantar pressure in diabetic men. Diabetes Care 14:750–755

    CAS  PubMed  Google Scholar 

  37. Caputo GM, Cavanagh PR, Ulbrecht JS et al (1994) Assessment and management of foot disease in patients with diabetes. N Engl J Med 331:854–860

    CAS  PubMed  Google Scholar 

  38. Charcot JM (1868) Sur quelques arthropathies qui paraiise d’ependre d’ une l’esion du cerveau ou de la mouelle épini’ere. Arch Physiol Norm Pathol 1:161–178

    Google Scholar 

  39. Jordan WR (1936) Neuritic manifestations in diabetes mellitus. Arch Intern Med 57:307–366

    Google Scholar 

  40. Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S (2002) Charcot neuroarthropathy in diabetes mellitus. Diabetologia 45:1085–1096

    CAS  PubMed  Google Scholar 

  41. Salini D, Harish K, Minnie P et al (2018) Prevalence of Charcot arthropathy in type 2 diabetes patients aged over 50 years with severe peripheral neuropathy: a retrospective study in a tertiary care South Indian Hospital. Indian J Endocrinol Metab 22:107–111

    PubMed  PubMed Central  Google Scholar 

  42. Ramanujam CL, Zgonis T (2017) The diabetic Charcot foot from 1936 to 2016: eighty years later and still growing. Clin Podiatr Med Surg 34:1–8

    PubMed  Google Scholar 

  43. Jeffcoate WJ, Game F, Cavanagh PR (2005) The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet 366:2058–2061

    CAS  PubMed  Google Scholar 

  44. Boyce BF, Xing L (2008) Functions of RANKL/RANK/OPG in bone modeling and remodeling. Arch Biochem Biophys 473:139–146

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Larson SA, Burns PR (2012) The pathogenesis of Charcot neuroarthropathy: current concepts. Diabet Foot Ankle 3

    Google Scholar 

  46. Katayama Y, Akatsu T, Yamamoto M et al (1996) Role of nonenzymatic glycosylation of type I collagen in diabetic osteopenia. J Bone Miner Res 11:931–937

    CAS  PubMed  Google Scholar 

  47. Jeffcoate WJ, Game FL (2010) New theories on the causes of the Charcot foot in diabetes. In: Frykberg RG (ed) The diabetic Charcot foot: principles and management. Data Trace Publishing Company, Brooklandville, MD, pp 29–44

    Google Scholar 

  48. Eichenholtz SN (1966) Charcot joints. Charles C. Thomas, Springfield, IL

    Google Scholar 

  49. Cofield RH, Morrison MJ, Beabout JW (1983) Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change. Foot Ankle 4:15–22

    CAS  PubMed  Google Scholar 

  50. Morrison WB, Ledermann HP (2002) Work-up of the diabetic foot. Radiol Clin North Am 40:1171–1192

    PubMed  Google Scholar 

  51. Caputo GM, Ulbrecht J, Cavanagh PR et al (1998) The Charcot foot in diabetes: six key points. Am Fam Physician 57:2705–2710

    CAS  PubMed  Google Scholar 

  52. Rogers LC, Frykberg RG, Armstrong G, Boulton AJM, Edmonds M, Ha Van G et al (2011) The Charcot foot in diabetes. Diabetes Care 34(9):2123–2129

    PubMed  PubMed Central  Google Scholar 

  53. Keidar Z, Militianu D, Melamed E et al (2005) The diabetic foot: initial experience with 18F-FDG PET/CT. J Nucl Med 46:444–449

    PubMed  Google Scholar 

  54. Armstrong DG, Lavery LA (1997) Monitoring healing of acute Charcot’s arthropathy with infrared dermal thermometry. J Rehabil Res Dev 34:317–321

    CAS  PubMed  Google Scholar 

  55. Durgia H, Sahoo J, Kamlanathan S et al (2018) Role of bisphosphonates in the management of acute Charcot foot. World J Diabetes 9(7):115–126

    PubMed  PubMed Central  Google Scholar 

  56. Dhawan V, Spratt KF, Pinzur MS et al (2005) Reliability of AOFAS diabetic foot questionnaire in Charcot arthropathy: stability, internal consistency, and measurable difference. Foot Ankle Int 26:717–731

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physiology, Faculty of Medicine, J N Medical College & Hospital, Aligarh Muslim University, Aligarh, India

    Ahmad Faraz

  2. Rajiv Gandhi Center for Diabetes & Endocrinology, Faculty of Medicine, J N Medical College & Hospital, Aligarh Muslim University, Aligarh, India

    Hamid Ashraf

  3. Department of Radio-diagnosis, Faculty of Medicine, J N Medical College & Hospital, Aligarh Muslim University, Aligarh, India

    Saifullah Khalid

  4. Department of Medicine, Faculty of Medicine, J N Medical College & Hospital, Aligarh Muslim University, Aligarh, India

    Razeen Fatima

Authors
  1. Ahmad Faraz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hamid Ashraf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saifullah Khalid
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Razeen Fatima
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia

    Mohammad Zubair

  2. Consultant, Diabetes & Endocrinology, Superspeciality Center, Aligarh, Uttar Pradesh, India

    Jamal Ahmad

  3. Ex-Chairperson-Department of Microbiology, Former Dean-Faculty of Medicine, J N Medical College & Hospital Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

    Abida Malik

  4. Research Associate, Bioanalytical Department, AXIS Clinicals, Hyderabad, Telangana, India

    Mallikarjuna Rao Talluri

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Faraz, A., Ashraf, H., Khalid, S., Fatima, R. (2021). Foot Pressure Abnormalities, Radiographic, and Charcot Changes in the Diabetic Foot. In: Zubair, M., Ahmad, J., Malik, A., Talluri, M.R. (eds) Diabetic Foot Ulcer. Springer, Singapore. https://doi.org/10.1007/978-981-15-7639-3_7

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-7639-3_7

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-7638-6

  • Online ISBN: 978-981-15-7639-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation