Neuropathy refers to damage or disruption in the normal functioning of the nerves that comprise the body’s nervous system. In the lower extremity, this can be of three types – sensory, motor and autonomic peripheral neuropathy.
Sensory neuropathy is characterised by a loss or reduction in pallhypaesthesia, superficial sensitivity and subjective paraesthesia. This is often accompanied by a reduced perception of temperature. Patients may also present a decrease in Achilles reflex and/or patellar reflex.
As described by Maren Volmer-Thole and Ralf Lobmann, from the Clinic for Endocrinology, Diabetology, Geriatric Medicine in Stuttgart, muscular dysfunction associated with neuropathic foot results from atrophy of the anterior muscle group of lower leg exerting strain during the rollover process with an increase on forefoot pressure.
Motor neuropathy further involves atrophy of small foot muscles which results in malpositioning of toes in addition to motor paresis and a loss of muscle self-reflexes. An early indication of the onset of motor neuropathy is considered to be a loss of Achilles tendon reflex.
The authors note that the combination of sensory and motor peripheral neuropathy can lead to an unequal foot load in combination with an insecure gait. This leads to the gradual development of hyperkeratosis in addition to an increase in plantar pressure load.
Sensory perception loss is one of the most common consequences of peripheral neuropathy, especially in the diabetic population. This is associated with postural imbalance due to an altered sense of lower limb positioning impairing the ability of the individual to respond successfully to threats to balance.
Paton et al. reviewed the effects of foot and ankle devices, including customised and prefabricated insoles, on balance, gait and falls in adults with sensory perception loss. The authors also aimed to highlight balance and gait deficits and fall risks in these patients for consideration in prescribing foot and ankle devices.
The findings of the review established that no foot and ankle device was reported to have a negative effect on the balance or gait of people with sensory perception loss. Postural sway was found to improve with vibrating insoles and ankle-foot orthoses.
Static balance and consistence of walking in people with peripheral neuropathy were observed to improve with foot and ankle devices; the authors attributed this to a combination of mechanical support and increased somatosensory awareness.
The use of custom foot orthotics such as MASS4D®, facilitates the smooth functioning of the central nervous system by stimulating the required biofeedback from the cutaneous receptors on the plantar surface of the feet.
In addition to this, MASS4D® elicits a specific dynamic response by filtering out information generated by ground reaction forces, which is transferred to the central nervous system, this is responsible for maintaining an optimal upright posture necessary for balance, and integrates visual, vestibular and somatosensory information.
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Diabetic foot infections represent a major foot complication for patients with diabetes mellitus, necessitating the implementation of efficient foot care practises and management programmes.