OBJECTIVETo investigate foot biomechanics characteristic of patients with type 2 diabetes mellitus.

METHODSThis study was conducted among 303 patients with type 2 diabetes. The whole foot was divided into 10 regions, namely the first toe (T1); the second to fifth toes (T2-5); the first, second, third, fourth, and fifth metatarsals (M1, M2, M3, M4, and M5, respectively); midfoot (MF), and the heel medial (HM). Foot arch index, foot angle and maximum peak pressure (MPP) of the 10 regions were measured using a Footscan gait system.

RESULTSThe maximum peak pressure of 10 regions decreased in the order of M3>M2>HM>M4>HL>M1>M5>T1>ML>T2-5 for the left foot, and in the order of M3>M2>HM>M4>HL>M1>M5>T1>ML>T2-5 for the right foot. The MPP in M1 region was higher in the right than in the left foot (P<0.05). The MPP in M3, M4, M5, and MF was higher in the left than in the right foot (P<0.05). The percentage of high-risk foot (defined by a total plantar pressure ≥70 N/cm) was 34% on the left and 17.7% on the right. An increased BMI was associated with a significant increase in high-risk foot, but not for the right foot in underweight patients. Foot flat phase was extended and forefoot push-off phase shortened in stance phase in the patients. Compared with the right foot, the left foot showed a significantly increased foot arch index and increased low and high arch rates with a decreased normal arch rate. Total plantar pressure was higher in of the left high arch foot than in normal arch foot. The foot angle was significantly larger on the right than on the left. The bilateral total plantar pressures were significantly greater in male patients (P<0.05) and increased with age but were not associated with the duration of DM, foot angle, or glycosylated hemoglobin level.

CONCLUSIONDiabetic patients have obvious alterations in foot biomechanics with abnormalities of the plantar pressure, and the percentage of high-risk foot increases in overweight and obese patients, suggesting the need of body weight control in these patients when administering offloading treatment for prevention of diabetic foot ulcer.

Biomechanical Phenomena ; Diabetes Mellitus, Type 2 ; physiopathology ; Diabetic Foot ; prevention & control ; Female ; Foot ; physiopathology ; Gait ; Heel ; physiopathology ; Humans ; Male ; Obesity ; physiopathology ; Overweight ; physiopathology ; Pressure

Gap junctions play a critical role in electrical synchronization and exchange of small molecules between neighboring cells; connexins are a family of structurally related transmembrane proteins that assemble to form vertebrate gap junctions. Hyperglycemia changes the structure gap junction proteins and their expression, resulting in obstruction of neural regeneration, vascular function and wound healing, and also promoting vascular atherosclerosis. These pathogenic factors would cause diabetic foot ulcers. This article reviews the involvement of connexins in pathogenesis of diabetic foot.
Atherosclerosis ; Connexins ; metabolism ; Diabetic Foot ; pathology ; Gap Junctions ; metabolism ; Humans ; Hyperglycemia ; physiopathology ; Regeneration ; Wound Healing

BACKGROUNDPlantar pressure serves as a key factor for predicting ulceration in the feet of diabetes patients. We designed this study to analyze plantar pressure changes and correlating risk factors in Chinese patients with type 2 diabetes.

METHODSWe recruited 65 patients with type 2 diabetes. They were invited to participate in the second wave 2 years later. The patients completed identical examinations at the baseline point and 2 years later. We obtained maximum force, maximum pressure, impulse, pressure-time integral, and loading rate values from 10 foot regions. We collected data on six history-based variables, six anthropometric variables, and four metabolic variables of the patients.

RESULTSOver the course of the study, significant plantar pressure increases in some forefoot portions were identified (P < 0.05), especially in the second to forth metatarsal heads. Decreases in heel impulse and pressure-time integral levels were also found (P < 0.05). Plantar pressure parameters increased with body mass index (BMI) levels. Hemoglobin A1c (HbA1c) changes were positively correlated with maximum force (β = 0.364, P = 0.001) and maximum pressure (β = 0.366, P = 0.002) changes in the first metatarsal head. Cholesterol changes were positively correlated with impulse changes in the lateral portion of the heel (β = 0.179, P = 0.072) and pressure-time integral changes in the second metatarsal head (β = 0.236, P = 0.020). Ankle-brachial index (ABI) changes were positively correlated with maximum force changes in the first metatarsal head (β = 0.137, P = 0.048). Neuropathy symptom score (NSS) and common peroneal nerve sensory nerve conduction velocity (SCV) changes were positively correlated with some plantar pressure changes. In addition, plantar pressure changes had a correlation with the appearance of infections, blisters (β = 0.244, P = 0.014), and calluses over the course of the study.

CONCLUSIONSWe should pay attention to the BMI, HbA1c, cholesterol, ABI, SCV, and NSS changes in the process of preventing high plantar pressure and ulceration. Some associated precautions may be taken with the appearance of infections, blisters, and calluses.

Adult ; Aged ; Asian Continental Ancestry Group ; Diabetes Mellitus, Type 2 ; physiopathology ; Diabetic Foot ; diagnosis ; physiopathology ; Female ; Foot ; physiopathology ; Humans ; Male ; Middle Aged ; Pressure ; Prospective Studies ; Risk Factors

This pictorial review aims to illustrate the various manifestations of the diabetic foot on magnetic resonance (MR) imaging. The utility of MR imaging and its imaging features in the diagnosis of pedal osteomyelitis are illustrated. There is often difficulty encountered in distinguishing osteomyelitis from neuroarthropathy, both clinically and on imaging. By providing an accurate diagnosis based on imaging, the radiologist plays a significant role in the management of patients with complications of diabetic foot.
Aged ; Aged, 80 and over ; Cellulitis ; diagnosis ; Diabetic Foot ; complications ; diagnosis ; Female ; Gangrene ; diagnosis ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteomyelitis ; diagnosis ; physiopathology ; Risk Factors ; Skin Diseases ; diagnosis ; Ulcer ; diagnosis

Diabetic Foot ; enzymology ; physiopathology ; Humans ; Matrix Metalloproteinases ; metabolism ; Wound Healing ; physiology

OBJECTIVETo observe the effect of Tongsaimai (TSM) tablets in treating foot trauma of diabetic foot (DF) model rats, and discuss its potential mechanism.

METHODMale SD rats were selected to duplicate the diabetic foot ulcer model and randomly divided into the blank control group, the model group, the metformin treatment group, and TSM 12.44, 6.22, 3.11 g x kg(-1) groups (n = 10). The healing of ulcer wounds were observed on day 1, 4, 8, 13 and 18. After 18 days, a histopathologic examination was conducted for ulcer tissues. The contents of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by hydroxylamine and TBA methods. The content of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were determined with the radioimmunoassay. The immunohistochemical method was used to observe the expression of vascular endothelial growth factor (VEGF) in ulcer tissues and the number of capillary vessels.

RESULTTSM could alleviate the pathological changes of diabetic foot rats, accelerate the ulcer healing on 4, 8, 13, 18 d, reduce MDA, IL-6, TNF-alpha, VEGF content in rat serum at 18 d (after the rehabilitation period), and enhance the SOD content. Specifically, the TSM 12.44 g x kg(-1) group showed significant differences compared with the model group (P < 0.05, P < 0.01). At 18 d after the treatment (the late rehabilitation period), the VEGF expression of TSM 12.44, 6.22 g x kg(-1) groups and the number of blood capillaries of the TSM 12.44 g x kg(-1) group were significantly lower than that of the model group (P < 0.05, P < 0.01).

CONCLUSIONTSM could promote the foot wound healing of DF model rats, reduce MDA, IL-6 and TNF-alpha levels in serum, increase the SOD content and decrease the VEGF expression and the number of blood capillaries in the late rehabilitation period. Its action mechanism may be related to the inhibition of oxidative stress injury and the inflammatory cell infiltration.

Animals ; Diabetic Foot ; drug therapy ; genetics ; metabolism ; physiopathology ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Interleukin-6 ; genetics ; metabolism ; Male ; Malondialdehyde ; metabolism ; Rats ; Rats, Sprague-Dawley ; Superoxide Dismutase ; genetics ; metabolism ; Tablets ; administration & dosage ; Vascular Endothelial Growth Factor A ; genetics ; metabolism ; Wound Healing ; drug effects

Foot ulcers increase morbidity and mortality in diabetic patients. Due to poor healing factors, surgical wound healing is questionable in diabetic patients. We report a patient with insulin-dependent diabetes mellitus, sensory neuropathy and microangiopathy, who had an infected stump of the right three middle digits and subsequent transmetatarsal amputation. The infected postoperative ulcer was treated with complex phototherapy, including laser and ultraviolet C (UVC) radiations. A total of 23 sessions of low-intensity laser therapy and UVC irradiation were administered over a five-week period. The infected surgical wound healed completely. During the three-month follow-up period, there was no recurrence of the ulcer, although the patient's metabolic profile remained unstable. Multimodal therapy combining UVC and laser may constitute a useful and side-effect-free alternative treatment modality for the induction of wound healing post metatarsal amputation in patients with unhealed diabetic ulcers.
Amputation ; adverse effects ; Diabetes Complications ; surgery ; Diabetes Mellitus, Type 1 ; physiopathology ; surgery ; Diabetic Foot ; physiopathology ; surgery ; Diabetic Neuropathies ; physiopathology ; Humans ; Laser Therapy ; methods ; Lasers ; Male ; Metatarsal Bones ; physiopathology ; Middle Aged ; Phototherapy ; methods ; Postoperative Complications ; therapy ; Time Factors ; Ultraviolet Rays ; Wound Healing ; Wound Infection ; therapy

OBJECTIVETo evaluate the clinical value of sweat function examination in early diagnosis of diabetic peripheral neuropathy (DPN).

METHODSNinety-eight hospitalized type 2 diabetic patients with or without DPN (DN and DC groups) according to Michigan Diabetic Neruopathy Score (DNS) and 40 healthy volunteers (NC group) were evaluated for their sweat function of the feet in relation to the peripheral autonomic nerve with sweat printing method using Neuropad. The Neuropad color-changing time was recorded to assess the sensitivity and specificity of sweat printing methods relative to DNS for DNP evaluation, and the correlation of the Neuropad color-changing time to DNS score was analyzed.

RESULTSThe average Neuropad color-changing time was 4.0-/+0.6, 4.3-/+1.2 and 23.0-/+6.1 min in NC, DC, and DN groups, respectively, showing significant differences between the 3 groups (P<0.05). The morbidity rate detected by sweat printing method was 62.2%, similar to that detected by DNS (57.1%, P>0.05). The sensitivity of the sweat printing method for DPN diagnosis was 92.8%, with specificity of 78.5%, positive predictive value of 93.2%, and negative predictive value of 78.6%. DNS showed significant positive correlation with the Neuropad color-changing time (r=0.46, P<0.05).

CONCLUSIONSweat printing method provides an objective, simple and reliable method for sweat function evaluation of the feet of type 2 diabetic patients to help in early DPN diagnosis, and quantification of the results of sweat printing method can be indicative of the DPN severity.

Case-Control Studies ; Color ; Diabetic Neuropathies ; diagnosis ; physiopathology ; Early Diagnosis ; Foot ; physiopathology ; Humans ; Male ; Middle Aged ; Sweating ; physiology ; Time Factors

OBJECTIVETo explore the bio-inductive effects of inorganic elements (Dermlin) on the human epithelial proliferation and differentiation and their promoting effects on skin wound healing.

METHODS1 ). Cellular test: Normal human skin epithelial cells were cultured with 20 g/L Dermlin supplemented culture medium (E group) and regular culture medium (C group), respectively. The cell proliferation rate and the expressions of type IV collagen and epidermal growth factor (EGF) in the supernatant were determined in 12 and 20 post culture days (PCD). (2). Animal test: Self-consubstantiality control was employed in the study. Sixty Sprague - Dawley rats were inflicted with two symmetric 10% TBSA of superficial or deep partial thickness scald on the back of each rat, and were divided into control[ C, with topical application of silver sulfadiazine (SD - Ag) cream to the wounds] and treatment (T, with 1 g/100 cm2 Dermlin topical application to the wounds) groups. The pathological changes in wound skin were observed and the wound healing rate was calculated on 3, 5, 7, 10, 14 and 18 post treatment day (PTD). (3). Randomized, double-blinded and consubstantiality control method was employed in the clinical trial. Ninety patients were enrolled in the clinical study, among them 30 cases with 60 donor site wounds, 30 with 60 superficial and 30 with 60 deep partial thickness burn wounds were included. Dermlin in dose of 1 g/100 cm2 was applied to the wounds in T group and SD - Ag cream in C group for up to 18 days. Furthermore, sixty patients with diabetic foot ulcers were included for 1 g/100 cm2 Dermlin treatment. The wound healing rate was observed. And the blood and urine test and the indices of hepatic and renal function were determined.

RESULTS1). Cellular test: The cell proliferation rate and the expression of type IV collagen and EGF in the culture supernatant were obviously higher than those in control group at the same time points (P < 0.01). 2). Animal test: Hyperplastic granulation tissue occurred in the rat wound in the T group since 5 PTD, while that occurred in the C group since 7 PTD. The healing rate of superficial thickness wound in T group on 7, 10, 14 PTD, and that of deep partial thickness wound in T group on 5, 10, 18 PTD were obviously higher than that in the C group (P <0.05). 3). Clinical study indicated that the wound healing rate of the patients with superficial or deep partial thickness scald in the T group was evidently higher than that in the C group on 5 and 10 PTD (P <0.05), but the wound healing time of the superficial, deep partial thickness wound and donor site wound in the T group was significantly shorter than that in the C group (P < 0.05). Before treatment, the square of the ulcers on the foot of the patients with diabetic was (39 +/- 28) cm2, and it was reduced to (19 +/- 23) cm2 2 weeks later, with the therapeutic efficacy reaching 62.5% . For all patients, no obvious change was found in the blood test and hepatic and renal function indices.

CONCLUSIONThe inorganic element (Dermlin) is beneficial to wound healing and to the proliferation and differentiation of epithelial cells.

Adolescent ; Adult ; Animals ; Burns ; drug therapy ; Cell Proliferation ; drug effects ; Cells, Cultured ; Diabetic Foot ; drug therapy ; Disease Models, Animal ; Double-Blind Method ; Epithelium ; Humans ; Inorganic Chemicals ; pharmacology ; therapeutic use ; Male ; Phosphorus Compounds ; pharmacology ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Skin ; drug effects ; physiopathology ; Wound Healing ; drug effects

Adult ; Aged ; Ankle ; blood supply ; Arteries ; Diabetic Foot ; diagnosis ; physiopathology ; Elbow ; blood supply ; Female ; Foot ; blood supply ; Humans ; Laser-Doppler Flowmetry ; Male ; Middle Aged