New developments in the biomechanics of the diabetic foot

Biomechanical issues are now widely recognized as being important in the tr eatment of diabetic foot disease. The purpose of the present review is to i dentify advances that have occurred since the previous International Confer ence on the Diabetic Foot in 1995 in the understanding of foot biomechanics in relation to diabetes. Attention continues to be focused on the identifi cation of a threshold plantar pressure that leads to tissue damage. Recent studies have suggested that peak barefoot pressure may be only 65% specific for the development of ulceration. The association between foot deformity and plantar pressure has been the subject of several quantitative studies, but new questions have been raised about the etiology of claw toes, The mea surement of shear stress continues to be an elusive goal although several s mall studies have presented possibly feasible technical approaches. The imp ortance of callus as a precursor to ulceration has been confirmed experimen tally and quantitative measures of motor neuropathy have been presented. Al though a number of new devices have been introduced as alternatives to the Total Contact Cast, few clinical studies of their efficacy are available ye t. New information on the properties of insole materials has been published including data on changes with repeated cycling. Complications of prophyla ctic surgery have been shown to include a high rate of Charcot fractures. T wo new series describing the fixation of such fractures have also been repo rted. Biomechanical issues have also been addressed in two sets of guidelin es for treatment that have recently been published. These many studies conf irm the central role of mechanical stress and its relief in the treatment o f neuropathic foot problems in diabetes. Copyright (C) 2000 John Wiley & So ns, Ltd.