Next, there is a condition known as limited joint mobility that exists in diabetic patients which is caused by collagen glycosylation and cross-linking of collagen bundles. Limited joint mobility has been implicated in elevated plantar pressures leading to foot ulcerations. Another type of foot deformity which can cause abnormal stress is Charcot changes, such as a rocker-bottom foot with bony prominences. Remember that Charcot can affect five specific sites within the foot, not just at the tarsal-metatarsal joints. Last, a factor that is often overlooked is shoegear.
Many diabetic patients make the mistake of wearing shoes which are too tight.
When purchasing new shoes, instruct your patients to break them in for fifteen minutes per day, beginning at the end of the day when their feet are maximally swollen. The result of abnormally high plantar stress is callus formation, which in turn contributes to increased plantar pressures. Abnormal stress and neuropathy are precipitating factors for plantar foot ulceration. A patient with a foot ulceration should never be placed in conventional footwear. Peripheral Vascular Disease Peripheral vascular disease can encompass macro and microangiopathy.