Biomechanical Characteristics of Diabetic Foot Syndrome Among Indians with Diabetes Peripheral Neuropathy

Abstract

In the previous chapter, we have learnt the biomechanical parameters of diabetic foot syndrome in general. In this chapter, we shall gain information regarding the biomechanical characteristics, clinical correlation, and foot profile among Indian population. The higher prevalence of type 2 diabetes in Asian Indian has been attributed to the so-called “Asian Indian Phenotype” that leads to unique clinical and biochemical changes in the body. The consequent changes that lead to various complications in microvasculature and microvasculature have been extensively reported in previous chapters. The biomechanical changes in type 2 diabetes mellitus are a relatively new area that requires proper attention. Kinetic variables reported by various authors include plantar pressure, pressure time integral, joint moment, and ground reaction force, whereas kinematics variables like joint angle, joint velocity, joint acceleration, and gait parameters have attained their importance in the recent past. We shall also learn the role of plantar pressure separately in the next chapter. In the presence of diabetes peripheral neuropathy, these changes are even greater, causing specific alteration in posture and gait biomechanics uniquely to Indian population. In addition, retinopathy, nephropathy, dermopathy, neurological pain, and claudication may also manifest and cause specific changes. There is a scarcity of data pertaining to overall biomechanical characteristics in an open and closed kinematic chain for Indian population. For instance, a study done in India using 3D Motion Analysis Software reported significant changes on certain kinetic and kinematic variables of foot consisting a smaller sample size (n = 20). The possible reasons for changes in these parameters were not very clear. It could be an altered biomechanics and musculoskeletal changes not only at the foot but at other joints of the body. It is also possible that the changes in foot occurred eventually as the consequent changes in the musculoskeletal system in terms of muscle weakness, muscle tightness, and neuropathic pain that lead to altered gait patterns. In addition, the postural changes in the body could lead to altered kinetics and kinematics in a closed chain biomechanics. Therefore, an overall examination along with motion analysis needs to be reported. This could give a better insight into all the possible reason to conclude why there is significant changes in kinetics and kinematic of foot in Indians with diabetic peripheral neuropathy. We have used the data of 120 type 2 diabetes mellitus Indians with diabetes peripheral neuropathy from Kastruba Hospital, Manipal, Karnataka, India to understand the biomechanical characteristics of diabetic foot syndrome as shown in tables below.