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Biomechanics of the Diabetic Foot: The Road to Foot Ulceration

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The Diabetic Foot

Abstract

One of the principal functions of the foot is to absorb shock during heel strike and adapt to the uneven surface of the ground during gait. In this function the subtalar joint plays a basic role. The subtalar joint allows motion in three planes and is described as pronation (a combination of eversion, abduction, and dorsiflexion) and supination (a combination of inversion, adduction, and plantar flexion) (1,2). The ankle joint is the major point for controlling sagittal plane movements of the leg relative to the foot, which is essential for bipedal ambulation over flat or uneven terrain (3). The midtarsal joint represents the functional articulation between the hindfoot and midfoot. The interrelationship of the subtalar and midtarsal joint provides full pronation and supination motions throughout the foot. The first metatarsophalangeal joint (MTPJ) incorporates the first metatarsal head, the base of the proximal phalanx, and the superior surfaces of the medial and lateral sesamoid bones within a single joint capsule. The main motion of the first MTPJ and the lesser MTPJs is in the sagittal plane (dorsiflexion and plantar flexion). During propulsion, the body weight is moving forward over the hallux, creating relative dorsiflexion of the first MTPJ. This occurs with the hallux planted firmly on the ground and with the heel lifting for propulsion. It has previously been reported that the force acting across the first MTPJ approximates body weight, whereas the force across other MTPJs is considerably less (4). In addition, maximum loading of the first metatarsal head and hallux is around the same time during stance in normal gait, highlighting the importance of the load-bearing function of the hallux and first metatarsal head.

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Authors
  1. Carine H. M. van Schie MSc, PhD
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  2. Andrew J. M. Boulton MD, FRCP
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Editors and Affiliations

  1. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Aristidis Veves MD, DSc , John M. Giurini DPM  & Frank W. LoGerfo MD ,  & 

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van Schie, C.H.M., Boulton, A.J.M. (2002). Biomechanics of the Diabetic Foot: The Road to Foot Ulceration . In: Veves, A., Giurini, J.M., LoGerfo, F.W. (eds) The Diabetic Foot. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-168-8_8

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  • DOI: https://doi.org/10.1007/978-1-59259-168-8_8

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-253-7

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