Abstract
Callus has been identified as a risk factor leading to severe diabetic foot ulcer; thus, it is necessary to prevent its formation. Callus formation under the first, second, and fifth metatarsal heads (MTHs) is associated with external forces (pressure and shear stress) during walking. However, the gait factors increasing the external forces remain undetermined. Thus, this study aims to identify the factors increasing the external forces to prevent callus formation. In 59 patients with diabetic neuropathy wearing their usual shoes, the external forces, and the lower extremity joint angles were measured using MEMS force sensors and motion sensors. The external forces and their relationship with the lower extremity joint angles and footwear size were determined. Risk factors causing high external forces on the first MTH included small flexion of the knee joint (p = 0.015) and large ankle pronation motion (p = 0.034) to obtain propulsion. For the second MTH, wearing excessively long footwear was identified (p = 0.026). For the fifth MTH, high external force was related to tight width footwear (p = 0.005). An effective intervention for preventing callus formation for the first MTH would involve assisting the push-off foot motion using rocker-sole footwear or gait training. For the second and fifth MTHs, wearing appropriate size footwear would be effective.
Highlights
Callus formation may lead to the development of foot ulcers and involves hyperkeratosis caused by excessive mechanical loading [1,2,3]
Sixty-four patients with diabetes visited the Diabetic Foot Outpatient Clinic, and 59 patients with diabetic neuropathy were included in the survey
Callus has been identified as a non-ulcerative pathology in patients with diabetic neuropathy, and it can lead to severe diabetic foot ulcer
Summary
Callus formation may lead to the development of foot ulcers and involves hyperkeratosis caused by excessive mechanical loading [1,2,3]. In over 82% of patients with diabetic foot ulcers, callus formation has been found to precede ulcer formation [4]. The relative risk of an ulcer developing under an area of callus has been reported to be 11.0 compared with that under an area without callus [5,6]. Once a foot ulcer occurs, treatment is difficult and takes considerable time [7], making prevention the better strategy for clinical management. 58.2% of community-dwelling older adults had corn and callus [8]. Even healthy people with mechanical hyperkeratotic lesions (callus) showed a decrease in Quality of Life (QoL) [9]. It is necessary to prevent callus formation
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