Structural and functional changes in the feet of young people with Type 1 diabetes mellitus

Abstract

Diabetes can affect the structure and function of the foot, resulting in severe limitation of mobility and reduction of life expectancy. Early warning signs include limited joint mobility (LJM), soft tissue changes, high plantar pressure (HPP), high pressure time integrals (P/TI) and plantar callus. These abnormalities were examined in 216 young people with diabetes and 57 controls. The fingers, toes, ankle subtalar and first metatarsophalangeal joints shows reduced motion and the plantar aponeurosis was thicker in diabetic subjects. Skin thickness was the same for diabetic and control subjects. LJM in the feet was more common in males and older subjects. Subtalar and finger LJM was associated with early sensory nerve changes and finger LJM was associated with retinopathy and higher HbAtc. Thicker plantar aponeurosis was associated with male gander and larger feet. High peak pressure, high P/TI and callus were no more common in diabetic subjects than controls. However, high P/TI and callus were associated with early sensory nerve changes in young people with diabetes. Diabetic subjects with callus were significantly older than those without callus. Those with HPP had higher body mass index and less motion at the first MTP joints than those without HPP. Although plantar callus, HPP and high P/TI were no more common in young people with diabetes these abnormailities may be complicated by diabetes. Cushioning, custom orthoses or both in combination significantly reduced peak pressure and P/TI in diabetic subjects.

Date of Award	2002
Original language	English