Vehicle ergonomics contributing to a diabetic foot ulcer

Abstract

Background: Diabetes mellitus continues to be a rising concern in the United States. It affects an estimated 9.4% of the population and approximately 1.5 million Americans are diagnosed annually. Approximately 85% of diabetic foot ulcers are associated with diabetic peripheral neuropathy and an infected diabetic foot ulcer is often the first sign of diabetes. There are countless studies within the literature that investigate how insensate feet and the manifestation of a foot ulcer further decrease quality of life and increase risk for mortality. Literature focuses on gait and kinematics that contribute to the formation of a diabetic foot ulcer. While pressure and shear forces are etiologic factors that may lead to the formation of diabetic foot ulcers, the position of the foot while driving an automobile has been ignored as a possible risk factor.

Case presentation: The clinical case will describe the events of healing a neuropathic diabetic foot ulcer beyond the standard of care treatment plan. It is one of the first case reports to describe vehicle ergonomics as an etiologic factor contributing to a diabetic foot ulcer. Once the patient becomes aware of the unnecessary source of pressure, education and care is provided to manage this likely source of daily pressure to the neuropathic foot.

Conclusion: The article emphasizes the importance of a complete assessment, including nontraditional factors, which may lead to diabetic complications.

Keywords: Diabetes mellitus; Diabetic foot; Diabetic foot ulcer; Diabetic peripheral neuropathy; Driving simulator; Pressure.

Fig. 1

DFU at plantar posterior right heel

Fig. 2

DARCO® HeelWedge™ shoe

Fig. 3

Healed DFU at plantar posterior right heel

Fig. 4

Re-ulcerated DFU at plantar posterior right heel