Sinh học lâm sàng và tác động của nó đến bàn chân tiểu đường

Nghiên cứu về sinh học lâm sàng và tác động của nó đối với bàn chân tiểu đường năm 2020, cung cấp thông tin quan trọng cho điều trị và phòng ngừa.

Trường đại học

Lovely Professional University

Chuyên ngành

Clinical Biomechanics

Người đăng

Ẩn danh

Thể loại

monograph

2020

185
0
0

Phí lưu trữ

45 Point

Mục lục chi tiết

Foreword

Preface by Dr. Animesh Hazari

Preface by Dr. Arun Maiya

1. Introduction and Understanding of the Diabetic Foot Syndrome

1.1. Classification of Diabetic Foot

1.2. University of Texas (Armstrong)

1.3. PEDIS Classification of Diabetic Foot

1.4. Traumatic Diabetic Foot

1.5. Neuroischemic Foot

2. Epidemiology and Current Status of Diabetes Mellitus and Diabetic Foot Syndrome

2.1. Etiological Classification of DM

2.1.1. Type 1 Diabetes Mellitus (T1DM)

2.1.2. Type 2 Diabetes Mellitus (T2DM)

2.1.3. Gestational Diabetes Mellitus

2.1.4. Other Specific Types

2.2. Epidemiology of Type 2 Diabetes Mellitus

2.3. Diabetes Peripheral Neuropathy

2.3.1. Acute Sensory Neuropathy

2.3.2. Chronic Sensorimotor Neuropathy

2.3.3. Length-Dependent Diabetic Polyneuropathy

2.4. Prevalence of DPN

2.5. Epidemiology of Foot Complications in Type 2 Diabetes Mellitus

2.5.1. Prevalence of Painful Neuropathy (pDPN)

2.6. Mortality Rate Due to Diabetes Mellitus and Diabetic Foot Syndrome

3. Pathomechanics of Diabetic Foot Syndrome

3.1. Etiopathogenesis of Diabetic Foot Syndrome

3.2. Neurological Mechanism of Diabetic Foot Syndrome

3.3. Neurological Features of Diabetic Foot Syndrome

3.4. Vascular Mechanism of Diabetic Foot Syndrome

3.5. Vascular Features of Diabetic Foot Syndrome

3.6. Musculoskeletal Mechanism of Diabetic Foot Syndrome

3.7. Musculoskeletal Features of Diabetic Foot Syndrome

3.8. Biomechanical Mechanism of Diabetic Foot Syndrome

4. Patient's Perspective on Diabetic Foot Syndrome

4.1. Social Impact of DFS

4.2. Quality of Life and Diabetic Foot

4.3. Morbidity and Mortality Related to DFS

4.4. Painful Neuropathy

5. Clinician's Perspective on Diabetic Foot Syndrome

5.1. Diagnostic Criteria for Type 2 DM

5.1.1. Fasting Blood Sugar Level (FBS)

5.1.2. Postprandial Blood Sugar Level (PPBS)

5.1.3. Random Blood Sugar Level (RBS)

5.2. Screening for Diabetic Foot Syndrome

5.3. Diabetes Peripheral Neuropathy Assessment

5.3.1. Sensory Neuropathy Assessment

5.4. Neuropathy Scales and Screening Tools

5.5. Nerve Conduction Velocity

5.6. Strength of Foot and Lower Limb Muscles

5.7. Balance and Coordination

6. Diabetic Foot Complications: Foot Deformities, Peripheral Vascular Disease, Claudication, Foot Ulcers, and Amputation

6.1. How Does a Diabetic Foot Complication Occur?

6.2. Etiological Classification of Diabetic Foot Complications

6.2.1. Diabetic Vascular Problems

6.3. Common Foot Deformities

6.3.1. Dry Skin and Diabetic Dermopathy

6.3.2. Nail Bed Infections

6.3.3. Clawing of Toes

6.4. Common Foot Complications

6.4.1. Peripheral Vascular Disease

6.4.2. Diabetic Foot Ulcers

6.4.3. Gangrene and Diabetic Foot Amputation

7. Diabetic Foot Ulcers: Case Presentations

7.1. Patient 4

8. Biomechanics of Diabetic Foot Syndrome

8.1. Biomechanics of Foot and Ankle Joint

8.2. Arthrokinematics at Ankle and Foot Complex

8.3. Metatarsophalangeal and Interphalangeal Joints

8.4. Closed Kinematic-Kinetic Chain

8.5. Biomechanics in Gait Among Diabetes Mellitus

8.5.1. Limited Range of Motion

8.5.2. Muscular Forces at Foot

8.6. Role of Foot Arches in Diabetic Foot Biomechanics

8.6.1. Functional Foot Types

9. Biomechanical Characteristics of Diabetic Foot Syndrome Among Indians with Diabetes Peripheral Neuropathy

9.1. Clinical and Biomechanical Characteristics

9.2. Biomechanical Characteristics and Clinical Correction

9.2.1. Kinetics and Kinematics

9.2.2. Gait Characteristics

10. Role of Plantar Pressure in Diabetic Foot Syndrome

10.1. Evidence for Role of Plantar Pressure in Diabetic Foot

10.2. Plantar Pressure in Relation to Plantar Fat Pad Thickness

10.3. Plantar Pressure in Relation to Foot Type

11. Biomechanical Assessment and Implications in Diabetic Foot Syndrome

11.1. Clinical Biomechanical Foot Analysis

11.1.1. Biomechanical Assessment for Muscle Strength

11.1.2. Biomechanical Assessment for Muscle Length

11.1.3. Biomechanical Assessment for Foot Arch

11.1.4. Assessment for Foot Deformity

11.1.5. Assessment of First Ray and Fifth Ray

11.2. Advanced Tools for Kinetic Analysis

11.3. Advanced Tools for Kinematic Analysis

11.4. Implication of Biomechanical Assessment on DFS

12. Important Biomechanical Features and Findings in Diabetic Foot Syndrome

12.1. Normal Joint Biomechanics During Gait

12.2. Findings from Kinematic Analysis

12.2.1. Joint Angular Velocity

12.3. Findings from Kinetic Analysis

12.4. Interpretation of Factors Causing Altered Foot Kinematics in Diabetes Mellitus

12.5. Interpretation of Factors Causing Altered Foot Kinetics in Diabetes Mellitus

13. Predictors of Diabetic Foot Syndrome

13.1. Predictors of Diabetic Foot Ulceration: Regression Model of Diabetic Foot Syndrome

14. Management of Diabetic Foot Syndrome

14.1. Step by Step Foot Care

14.2. Foot Wear Assessment

14.3. Detailed Foot Assessment as Preventive

References

Tóm tắt

I. Tổng quan về tác động của sinh học lâm sàng đến bàn chân tiểu đường

Bàn chân tiểu đường là một trong những biến chứng nghiêm trọng của bệnh tiểu đường, ảnh hưởng đến chất lượng cuộc sống của bệnh nhân. Tác động của sinh học lâm sàng đến bàn chân tiểu đường không chỉ liên quan đến các yếu tố sinh lý mà còn đến các yếu tố cơ học. Hiểu rõ về sinh học lâm sàng giúp phát triển các phương pháp điều trị hiệu quả hơn.

1.1. Định nghĩa và phân loại bàn chân tiểu đường

Bàn chân tiểu đường được phân loại thành nhiều loại khác nhau, bao gồm bàn chân loét, bàn chân nhiễm trùng và bàn chân biến dạng. Mỗi loại có những đặc điểm và cách điều trị riêng.

1.2. Tầm quan trọng của sinh học lâm sàng trong điều trị

Sinh học lâm sàng cung cấp cái nhìn sâu sắc về cơ chế bệnh lý của bàn chân tiểu đường, từ đó giúp các bác sĩ đưa ra các phương pháp điều trị phù hợp và hiệu quả hơn.

II. Vấn đề và thách thức trong chăm sóc bàn chân tiểu đường

Chăm sóc bàn chân tiểu đường gặp nhiều thách thức, bao gồm việc phát hiện sớm các biến chứng và quản lý hiệu quả các triệu chứng. Nhiều bệnh nhân không nhận thức được tầm quan trọng của việc chăm sóc bàn chân, dẫn đến tình trạng nặng hơn.

2.1. Nguyên nhân gây tổn thương bàn chân tiểu đường

Tổn thương bàn chân tiểu đường thường do các yếu tố như bệnh lý thần kinh, bệnh lý mạch máu và áp lực quá mức lên bàn chân. Những yếu tố này cần được nhận diện và quản lý kịp thời.

2.2. Những thách thức trong việc phát hiện sớm

Việc phát hiện sớm các triệu chứng của bàn chân tiểu đường là rất quan trọng. Tuy nhiên, nhiều bệnh nhân thường bỏ qua các dấu hiệu ban đầu, dẫn đến tình trạng nghiêm trọng hơn.

III. Phương pháp điều trị hiệu quả cho bàn chân tiểu đường

Có nhiều phương pháp điều trị cho bàn chân tiểu đường, từ chăm sóc tại nhà đến can thiệp y tế. Việc lựa chọn phương pháp phù hợp phụ thuộc vào tình trạng cụ thể của bệnh nhân.

3.1. Chăm sóc tại nhà cho bàn chân tiểu đường

Chăm sóc tại nhà bao gồm việc giữ cho bàn chân sạch sẽ, khô ráo và kiểm tra thường xuyên để phát hiện sớm các dấu hiệu bất thường.

3.2. Can thiệp y tế và phẫu thuật

Trong một số trường hợp, can thiệp y tế hoặc phẫu thuật có thể cần thiết để điều trị các biến chứng nghiêm trọng của bàn chân tiểu đường.

IV. Ứng dụng thực tiễn của sinh học lâm sàng trong điều trị

Sinh học lâm sàng không chỉ giúp hiểu rõ hơn về cơ chế bệnh lý mà còn cung cấp các công cụ và phương pháp để điều trị hiệu quả hơn. Các nghiên cứu gần đây đã chỉ ra rằng việc áp dụng sinh học lâm sàng có thể cải thiện đáng kể kết quả điều trị.

4.1. Nghiên cứu và ứng dụng công nghệ mới

Công nghệ mới trong sinh học lâm sàng giúp theo dõi và đánh giá tình trạng bàn chân tiểu đường một cách chính xác hơn, từ đó đưa ra các phương pháp điều trị kịp thời.

4.2. Kết quả nghiên cứu về sinh học lâm sàng

Nhiều nghiên cứu đã chỉ ra rằng việc áp dụng các phương pháp sinh học lâm sàng có thể giảm thiểu nguy cơ biến chứng và cải thiện chất lượng cuộc sống cho bệnh nhân.

V. Kết luận và tương lai của chăm sóc bàn chân tiểu đường

Chăm sóc bàn chân tiểu đường cần được chú trọng hơn trong điều trị bệnh tiểu đường. Tương lai của chăm sóc bàn chân tiểu đường sẽ phụ thuộc vào việc áp dụng các phương pháp sinh học lâm sàng và công nghệ mới.

5.1. Tầm quan trọng của giáo dục bệnh nhân

Giáo dục bệnh nhân về tầm quan trọng của chăm sóc bàn chân là rất cần thiết để giảm thiểu nguy cơ biến chứng.

5.2. Hướng đi mới trong nghiên cứu và điều trị

Nghiên cứu và phát triển các phương pháp điều trị mới sẽ giúp cải thiện hiệu quả chăm sóc bàn chân tiểu đường trong tương lai.

14/08/2025

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Clinical Biomechanics and its Implications on Diabetic Foot Animesh Hazari G. Arun Maiya sachyhoc.com 123 Clinical Biomechanics and its Implications on Diabetic Foot Animesh Hazari • G. Arun Maiya Clinical Biomechanics and its Implications on Diabetic Foot Animesh Hazari G. Arun Maiya LFAMS, Lovely Professional University Centre for Diabetic Foot Care and Jalandhar Research, MAHE Punjab Manipal India Karnataka India ISBN 978-981-15-3680-9    ISBN 978-981-15-3681-6 (eBook) https://doi.1007/978-981-15-3681-6 © Springer Nature Singapore Pte Ltd.

2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.

The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Foreword Diabetes is a major public health problem of global importance. With the increase in the age of the global population, the incidence of this chronic complex metabolic disease is growing in alarming proportions. The biomechanics of the diabetic foot is altered and maladaptive. We lack a thorough understanding of the functional conse- quences of limb salvage.

We currently rely on observation and descriptive data per- taining to the biomechanics of the diabetic foot. Technology has driven our ability to objectively describe the biomechanics of the diabetic foot. Dynamic segmental and gait analyses in conjunction with peak plantar pressure measurements have provided valuable insights. The biomechanical pathogenesis of a chronic ulceration that necessitates limb salvage is difficult to capture.

Ultimately, a better understand- ing of the biomechanics of the diabetic foot would allow us to better select the most appropriate treatment regime to follow and thus save the diabetic foot from amputation. As the founder and president of Indian Podiatry Association, I have always pro- moted and encouraged our members to “think out of the box,” come up with new treatment regimes for medical healthcare, and work toward the motto we follow— save limb amputation. I am delighted to write the foreword to this provocative monograph, which sheds light on a different approach to the biomechanics of the diabetic foot. Arun Maiya whom I know for many years is a senior advisor to IPA and President of Karnataka Chapter of IPA.

He is a national figure in his field and is best suited for the Diabetic Foot Management book which he and Dr. Animesh Hazari have written. I hope many students and doctors all across will benefit from this book. MaIya and Dr.

Animesh Hazari great success, in their efforts and hope they find a large number of followers to this new approach to Clinical Biomechanics and its Implications on Diabetic Foot. Suri Diabetic Footcare Centre New Delhi, India Indian Podiatry Association New Delhi, India v Preface by Dr. Animesh Hazari The interest of being a healthcare professional with an expertise in diabetic foot syn- drome was recognized in my early childhood at the age of 13 years, when I lost my grandfather due to diabetic foot complications. It was very difficult to understand at that time “how a small nail in the feet could become such a serious issue and lead to sudden death of an individual.” From that instance, it was my dream to work and write a book and present some valuable information in the area of diabetic foot syndrome.

The idea of writing this book started in 2017 during my Ph.D when I published few articles in reputed journals and got excellent appraisal for the work. All the informa- tion provided in this book is original with an experience of understanding the topic in depth, evolved during my Ph.D research work among Indian population. In India, diabetic foot syndrome has not been taken very seriously till date, and this is my attempt to serve the people of the nation through my personal and rigorous scientific observations. I believe that having saved even one life through the information pre- sented in this book could make our research work priceless.

There are a few people I would like to acknowledge as I strongly believe that they have a direct or indirect role in the completion of this task. First of all, my grandfather “Late Mr. Pashupati Nath Jha” who was an inspiration for understand- ing the topic with immense seriousness. Following him, I would like to thank my parents “Mr.

Krishna Kumar Hazari and Mrs. Rita Hazari” for providing me an opportunity for the highest education at the national and international platforms. Without their sacrifice and vision, I would stand nowhere. Having recalled parents and almighty for their seamless blessings, I would like to recall the support of my wife “Mrs.

Rakhi Hazari” standing strong at all times through the troughs and crests of my life. Nevertheless being blessed with the most adorable daughter “Anika” who may have suffered with negligence and limited affection at times of my busy work, I thank her for understanding father’s priority. It is the blessing of my supervi- sor Dr. Arun Maiya and co-supvisor for Ph.

Shivashankara K N who have supported me throught my academic carrer while also providing deep insights and contribution to the book through his efficient clinical expertise in Diabetes Mellitus. I have also been blessed with loving and affectionate companionship with friends like Dr. Hrishikesh, vii viii Preface by Dr. Animesh Hazari Dr.

Anujot Kaur, Dr. Bhanu Thapar, Dr. Digvijay Chauhan and Dr. Also from the deepest core of my heart, I am grateful to all my patients who provided their consent for being part of my research work.

It is a pleasure to acknowledge my students like Riya Brahmi, Prishita Kumar, and Sushant Chahal who have supported this book through their contribution in drawing the original pictures. At last I would also like to thank all my well wishers who believed in my potential and all the critics who made me push myself harder and stronger and keep striving for the best. “Aim! Assess! Acknowledge!” Punjab, India Animesh Hazari Preface by Dr. Arun Maiya Diabetic foot assessment and care is one of the upcoming multidisciplinary special- ity in clinical practice and academics.

Although there are a large number of books on diabetic foot care, very few are targeted at clinical biomechanics and its implica- tions on diabetic foot syndrome. This book is designed to fill the gap and make the interpretation of the biomechanics in diabetic foot syndrome as simple as possible for various health care professionals. Even though diabetes and diabetic foot com- plications in India are increasing, there is a need for capacity building of health care professionals in the assessment and management of diabetic foot syndrome. Based on our large community-based diabetic foot research funded by the World Diabetes Foundation, we observed that there is a need for proper training of health care pro- fessionals in the management of diabetic foot syndrome.

Therefore, this book should remain a useful aid for all professionals, students, and researchers working in the field of diabetic foot syndrome. I would like to thank my lead author Dr. Animesh Hazari for taking the initiative to write the book, and I would like to thank all my well-wishers who believed in my academic and research experience and expertise in the field. I would like to thank my institution and university for the continued support in our entire academic and research endeavors and for the strong support.

Arun Maiya ix Contents 1 Introduction and Understanding of the Diabetic Foot Syndrome��������   1 1.1 Classification of Diabetic Foot������������������������������������������������������������   2 1.2 University of Texas (Armstrong)��������������������������������������������   4 1.3 PEDIS Classification of Diabetic Foot ����������������������������������   4 1.1 Traumatic Diabetic Foot �������������������������������������������������������� 11 1.2 Neuroischemic Foot���������������������������������������������������������������� 11 References���������������������������������������������������������������������������������������������������� 11 2 Epidemiology and Current Status of Diabetes Mellitus and Diabetic Foot Syndrome�������������������������������������������������������������������� 13 2.1 Etiological Classification of DM�������������������������������������������������������� 13 2.1 Type 1 Diabetes Mellitus (T1DM)������������������������������������������ 13 2.2 Type 2 Diabetes Mellitus (T2DM)������������������������������������������ 13 2.3 Gestational Diabetes Mellitus ������������������������������������������������ 14 2.4 Other Specific Types �������������������������������������������������������������� 14 2.2 Epidemiology of Type 2 Diabetes Mellitus���������������������������������������� 14 2.3 Diabetes Peripheral Neuropathy �������������������������������������������������������� 16 2.1 Acute Sensory Neuropathy ���������������������������������������������������� 16 2.2 Chronic Sensorimotor Neuropathy ���������������������������������������� 16 2.3 Length-Dependent Diabetic Polyneuropathy�������������������������� 17 2.4 Prevalence of DPN������������������������������������������������������������������������������ 17 2.5 Epidemiology of Foot Complications in Type 2 Diabetes Mellitus���� 18 2.1 Prevalence of Painful Neuropathy (pDPN)���������������������������� 20 2.6 Mortality Rate Due to Diabetes Mellitus and Diabetic Foot Syndrome�������������������������������������������������������������������������������������������� 20 References���������������������������������������������������������������������������������������������������� 21 3 Pathomechanics of Diabetic Foot Syndrome ������������������������������������������ 23 3.1 Etiopathogenesis of Diabetic Foot Syndrome������������������������������������ 23 3.2 Neurological Mechanism of Diabetic Foot Syndrome ���������������������� 25 3.3 Neurological Features of Diabetic Foot Syndrome���������������������������� 26 xi xii Contents 3.4 Vascular Mechanism of Diabetic Foot Syndrome������������������������������ 27 3.5 Vascular Features of Diabetic Foot Syndrome������������������������������������ 27 3.6 Musculoskeletal Mechanism of Diabetic Foot Syndrome������������������ 27 3.7 Musculoskeletal Features of Diabetic Foot Syndrome ���������������������� 29 3.8 Biomechanical Mechanism of Diabetic Foot Syndrome�������������������� 29 References���������������������������������������������������������������������������������������������������� 30 4 Patient’s Perspective on Diabetic Foot Syndrome���������������������������������� 33 4.1 Social Impact of DFS�������������������������������������������������������������������������� 33 4.3 Quality of Life and Diabetic Foot ������������������������������������������������������ 34 4.5 Morbidity and Mortality Related to DFS�������������������������������������������� 36 4.6 Painful Neuropathy ���������������������������������������������������������������������������� 36 References���������������������������������������������������������������������������������������������������� 37 5 Clinician’s Perspective on Diabetic Foot Syndrome ������������������������������ 39 5.1 Diagnostic Criteria for Type 2 DM ���������������������������������������������������� 39 5.1 Fasting Blood Sugar Level (FBS) ������������������������������������������ 39 5.2 Postprandial Blood Sugar Level (PPBS)�������������������������������� 40 5.3 Random Blood Sugar Level (RBS)���������������������������������������� 40 5.2 Screening for Diabetic Foot Syndrome���������������������������������������������� 40 5.3 Diabetes Peripheral Neuropathy Assessment�������������������������������������� 40 5.1 Sensory Neuropathy Assessment�������������������������������������������� 41 5.4 Neuropathy Scales and Screening Tools�������������������������������� 42 5.5 Nerve Conduction Velocity ���������������������������������������������������� 43 5.1 Strength of Foot and Lower Limb Muscles���������������������������� 46 5.3 Balance and Coordination������������������������������������������������������ 47 References���������������������������������������������������������������������������������������������������� 47 6 Diabetic Foot Complications: Foot Deformities, Peripheral Vascular Disease, Claudication, Foot Ulcers, and Amputation ������������ 49 6.2 How Does a Diabetic Foot Complication Occur?������������������������������ 49 6.3 Etiological Classification of Diabetic Foot Complications���������������� 50 6.2 Diabetic Vascular Problems���������������������������������������������������� 51 6.4 Common Foot Deformities ���������������������������������������������������������������� 51 6.1 Dry Skin and Diabetic Dermopathy���������������������������������������� 51 Contents xiii 6.3 Nail Bed Infections ���������������������������������������������������������������� 53 6.4 Clawing of Toes���������������������������������������������������������������������� 53 6.5 Common Foot Complications ������������������������������������������������������������ 56 6.1 Peripheral Vascular Disease���������������������������������������������������� 56 6.2 Diabetic Foot Ulcers �������������������������������������������������������������� 56 6.3 Gangrene and Diabetic Foot Amputation ������������������������������ 57 References���������������������������������������������������������������������������������������������������� 58 7 Diabetic Foot Ulcers: Case Presentations������������������������������������������������ 59 7.4 Patient 4����������������������������������������������������������������������������������������������   63 8 Biomechanics of Diabetic Foot Syndrome ���������������������������������������������� 65 8.2 Biomechanics of Foot and Ankle Joint ���������������������������������������������� 66 8.3 Arthrokinematics at Ankle and Foot Complex ���������������������������������� 66 8.5 Metatarsophalangeal and Interphalangeal Joints�������������������� 67 8.4 Closed Kinematic-Kinetic Chain�������������������������������������������������������� 67 8.5 Biomechanics in Gait Among Diabetes Mellitus�������������������������������� 67 8.1 Limited Range of Motion������������������������������������������������������� 69 8.2 Muscular Forces at Foot���������������������������������������������������������� 69 8.6 Role of Foot Arches in Diabetic Foot Biomechanics�������������������������� 70 8.1 Functional Foot Types������������������������������������������������������������ 70 References���������������������������������������������������������������������������������������������������� 73 9 Biomechanical Characteristics of Diabetic Foot Syndrome Among Indians with Diabetes Peripheral Neuropathy���������������������������������������� 75 9.2 Clinical and Biomechanical Characteristics �������������������������������������� 76 9.3 Biomechanical Characteristics and Clinical Correction �������������������� 79 9.1 Kinetics and Kinematics �������������������������������������������������������� 79 9.2 Gait Characteristics���������������������������������������������������������������� 81 References���������������������������������������������������������������������������������������������������� 82 xiv Contents 10 Role of Plantar Pressure in Diabetic Foot Syndrome ���������������������������� 83 10.1 Evidence for Role of Plantar Pressure in Diabetic Foot ������������������ 84 10.

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