Evaluacion de la rigidez de tobillo en pacientes diabeticos con amputaciones distales atipicas

Resumo

BACKGROUND: A risk factor for secondary amputations due to diabetes could be ankle stiffness, that could impair the biomechanical pattern. The aim of this study was to evaluate the rigidity of the ankle joint in diabetic patients that have undergone atypical distal amputations. MATERIALS AND METHODS: We studied 62 patients that had suffered an atypical amputation specifically in one of their feet and we classified them into 3 groups. The first had first ray pathology, the other had the lesser digits and the third was affecting the central rays. We evaluated their habits, both bad habits and healthy ones, their index of foot posture, and we used the IAROM device to determine the differences in rigidity of the ankle between their feet. RESULTS: The diabetic patients that suffered an atypical distal amputation had a poor metabolic control (HgA1c 7.01+- 0.9) bad habits (60% alcoholism and or tobacco abuse) and 80% did not do any physical activity. Foot posture in amputated feet don´t change related non amputated (3.7 vs 3.1, p=0.221), but seems to be a trend towards pronation. The feet with atypical amputations presented a 3º lesser range of movement than the contralateral foot (p=0.001), independently of the applied forces (45, 67, 89, 111N). CONCLUSIONS: The increased ankle rigidity and pronated foot posture may be contributing factors in the development of ulcers in diabetic patients. We consider that, due to the asymmetry of the human body, one leg may have more predisposition to suffer an ulcer.