Contemporary Evaluation and Management of the Diabetic Foot
Figure 1
Biomechanics of foot ulcers. (a) The biomechanics of gait. The first action is heel strike, when the lateral calcaneus makes contact with the ground and the muscles, tendons, and ligaments relax, providing for optimal energy absorption. The second is midstance, when the foot is flat and is able to adapt to uneven terrain, maintain equilibrium, and absorb the shock of touchdown. The third is heel rise followed by toe push-off, when the calcaneus lifts off the ground, the foot pronates, the muscles, tendons, and ligaments tighten, and the foot regains its arch. (b) The forces on the foot. (c) Callus formation. Adapted from NEJM [9] with the permission of the publisher.
