From the Guidelines
Type 1 deformity, also known as a bony deformity, is a significant risk factor for amputation in individuals with diabetes, and its management is crucial to prevent complications. This condition is characterized by altered biomechanics, which can lead to increased pressure on specific areas of the foot, resulting in erythema, callus formation, or even ulcers 1. The presence of bony deformities, such as hammertoes, prominent metatarsal heads, or bunions, requires special attention and management to prevent further complications.
Risk Factors and Management
The risk of ulcers or amputations is increased in people with diabetes who have bony deformities, peripheral neuropathy, or peripheral vascular disease 1. To manage high-risk conditions, individuals with bony deformities may need extra-wide shoes or depth shoes to accommodate their foot structure. In some cases, custom-molded shoes may be necessary to redistribute pressure and prevent tissue damage. Callus debridement by a foot care specialist or other health professional with experience and training in foot care can also help prevent complications.
Prevention and Monitoring
Preventing high-risk conditions is critical in managing type 1 deformity. Maintaining glycemic levels as near normal as possible can delay the development of neuropathy, a significant predictor of ulcers and amputation 1. Smoking cessation and timely referral to a foot care specialist are also essential in reducing the risk of vascular disease complications. Individuals with diabetes should receive an annual foot examination to identify high-risk foot conditions, including assessment of protective sensation, foot structure and biomechanics, vascular status, and skin integrity 1.
Key Considerations
- Bony deformities are a significant risk factor for amputation in individuals with diabetes
- Management of high-risk conditions requires special attention to foot structure and biomechanics
- Preventing high-risk conditions through glycemic control, smoking cessation, and timely referral to a foot care specialist is crucial
- Annual foot examinations are essential to identify high-risk foot conditions and prevent complications 1
From the Research
Types of Deformities
- Scoliosis: a spinal deformity consisting of lateral curvature and rotation of the vertebrae 2
- Clubfoot or talipes equinovarus deformity: one of the most common anomalies affecting the lower extremities 3
Characteristics of Deformities
- Scoliosis can be classified as congenital, neuromuscular, syndrome-related, idiopathic, or spinal curvature due to secondary reasons 2
- Clubfoot deformity can be assessed using three-dimensional reconstruction of transverse CT images to quantitate interosseous deformity and visualize intraosseous deformity 4
Treatment and Evaluation
- The treatment for idiopathic scoliosis is based on age, curve magnitude, and risk of progression, and includes observation, orthotic management, and surgical correction with fusion 2
- The Ponseti method is considered the gold standard of treatment for primary clubfoot, but relapse is common and other interventions may be necessary for long-term successful outcomes 3
- A complete patient assessment for adult spinal deformity must include a thorough history, physical examination, and appropriate imaging studies to characterize the extent of the deformity and determine the need for surgical intervention 5