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Biomechanical Risk Factors Associated with Neuropathic Ulceration of the Hallux in People with Diabetes Mellitus

Vanessa L. Nubé, DipAppSci(Pod), MSci(Med) ^* , Lynda Molyneaux, RN  and Dennis K. Yue, MD, PhD ^* 

^* Discipline of Medicine, University of Sydney, Sydney, Australia.
Diabetes Centre, Royal Prince Alfred Hospital, Sydney, Australia.

Corresponding author: Vanessa L. Nubé, DipAppSci(Pod), MSci(Med), Diabetes Centre, Royal Prince Alfred Hospital, Level 6, West Wing, Missenden Rd, Camperdown, New South Wales 2050, Australia.

Abstract

In this study of people with diabetes mellitus and peripheral neuropathy, it was found that the feet of patients with a history of hallux ulceration were more pronated and less able to complete a single-leg heel rise compared with the feet of patients with a history of ulceration elsewhere on the foot. The range of active first metatarsophalangeal joint dorsiflexion was found to be significantly lower in the affected foot. Ankle dorsiflexion, subtalar joint range of motion, and angle of gait differed from normal values but were similar to those found in other studies involving diabetic subjects and were not important factors in the occurrence of hallux ulceration. These data indicate that a more pronated foot type is associated with hallux ulceration in diabetic feet. Further studies are required to evaluate the efficacy of footwear and orthoses in altering foot posture to manage hallux ulceration. (J Am Podiatr Med Assoc 96(3): 189–197, 2006)

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