Podiatric physicians and surgeons have a more intimate knowledge of foot function than most of the other medical disciplines. The understanding they have of pedal deformities, splints, off-loading devices and their ability to perform surgical procedures for preventative and therapeutic purposes make them uniquely qualified to treat diabetic foot ulcerations.

Dr. Larry DiDomenico discusses biomechanical risk factors of the diabetic foot in this lecture. We revisit our old adversary, "the equinus deformity" and its role in greatly magnifying plantar pressures of the foot. (view Dr. DiDomenico's lecture on Endoscopic Gastocnemius Recession in Surgery 1 CME Lecture Track).

Peak plantar pressures are reduced 27% by lengthening the Achilles Tendon (Armstrong, et.al.). Dr. DiDomenico explains how this concept can greatly improve outcomes in Charcot Reconstruction, Transmetatarsal amputations and treatment of forefoot ulcerations.

A proper orthopedic assessment in the diabetic foot should include an evaluation of the range of motion, the integrity of the plantar fat pad, digital contractures, the position of the hallux, varus or valgus positions of the foot and, of course, whether or not an equinus deformity exists. Dr. DiDomenico explains how motor neuropathy and subsequent muscle imbalances contribute to the development of pedal deformities.

Learn why a resistant ulcer under the IP joint of the hallux may actually be present as a result of functional hallux limitus. See how Tailors Bunions and Hallux Abducto Valgus deformities contribute to ulcer formation. Dr. DiDomenico then discusses salvage procedures, bracing, orthotics, off-loading devices, and proper shoe gear. All these techniques are designed to restore function, avoid pressure, and balance the foot. He emphasizes the importance of understanding other risk factors as well and how they will contribute to a successful outcome.