Foot motion in diabetes

NewsBot · Feb 27, 2007

Members do not see these Ads. Sign Up.
Segmental foot mobility in individuals with and without diabetes and neuropathy.
Rao S, Saltzman C, Yack HJ.
Clin Biomech. 2007 Feb 21; [Epub ahead of print]

BACKGROUND: Impairment in intrinsic foot mobility has been identified as an important potential contributor to altered foot function in individuals with diabetes mellitus and neuropathy, however the role of limited foot mobility in gait remains poorly understood. The purpose of our study was to examine segmental foot mobility during gait in subjects with and without diabetes and neuropathy.

METHODS: Segmental foot mobility during gait was examined using a multi-segment kinematic foot model in subjects with diabetes (n=15) and non-diabetic control subjects (n=15).

FINDINGS: Subjects with diabetes showed reduced frontal as well as sagittal plane excursion of the calcaneus relative to the tibia. Decreased excursion of the first metatarsal relative to the calcaneus in the frontal as well as transverse plane was noted in subjects with diabetes.

INTERPRETATION: Our findings agree with traditional understanding of foot mechanics and shed new light on patterns and magnitude of motion during gait. Calcaneal pronation, noted in early stance in both groups, was reduced in subjects with diabetes and may have important consequences on joints proximal as well as distal to it. Subjects with diabetes showed reduced foot 'splay' in early stance, indicated by first metatarsal and forefoot eversion. At terminal stance, decreases in calcaneal plantarflexion, first metatarsal and forefoot supination were noted in subjects with diabetes, suggesting that less supination is required in subjects with diabetes to create a rigid lever. In subjects with diabetes, a greater proportion of midfoot stability may be derived from modified/stiffer soft tissue such as the plantar fascia.
Click to expand...

NewsBot · Jul 8, 2008

BMC Musculoskelet Disord. 2008 Jul 4;9(1):99. [Epub ahead of print]
Muscle performance and ankle joint mobility in long-term patients with diabetes.
Giacomozzi C, D'Ambrogi E, Cesinaro S, Macellari V, Uccioli L.
BMC Musculoskelet Disord. 2008 Jul 4;9(1):99. [Epub ahead of print]

BACKGROUND: Long-term patients with diabetes and peripheral neuropathy show altered foot biomechanics and abnormal foot loading. This study aimed at assessing muscle performance and ankle mobility in such patients under controlled conditions.

METHODS: Forty six long-term diabetes patients with (DN) and without (D) peripheral neuropathy, and 21 controls (C) were examined. Lower leg muscle performance and ankle mobility were assessed by means of a dedicated equipment, with the patient seated and the examined limb unloaded. 3D active ranges of motion and moments of force were recorded, the latter during maximal isometric contractions, with the foot blocked in different positions.

RESULTS: All patients showed reduced ankle mobility. In the sagittal and transversal planes reduction vs C was 11% and 20% for D, 20% and 21% for DN, respectively. Dorsal-flexing moments were significantly reduced in all patients and foot positions, the highest reduction being 28% for D and 37% for DN. Reductions of plantar-flexing moments were in the range 12-15% for D (only with the foot blocked in neutral and in dorsal-flexed position), and in the range 10-24% for DN. In all patients, reductions in the frontal and transversal planes ranged 14-41%.

CONCLUSIONS: The investigation revealed ankle functional impairments in patients with diabetes, with or without neuropathy, thus suggesting that other mechanisms besides neuropathy might contribute to alter foot-ankle biomechanics. Such impairments may then play a role in the development of abnormal gait and in the onset of plantar ulcers.
Click to expand...

Admin2 · Jul 9, 2008

Related:
Other diabetes & biomechanics threads

NewsBot · Feb 5, 2009

Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy.

Savelberg HH, Schaper NC, Willems PJ, De Lange TL, Meijer K.
BMC Musculoskelet Disord. 2009 Feb 3;10(1):16. [Epub ahead of print]

BACKGROUND: Patients with diabetic polyneuropathy (DPN) are often confronted with ulceration of foot soles. Increased plantar pressure under the forefoot has been identified as a major risk factor for ulceration. This study sets out to test the hypothesis that changes in gait characteristics induced by DPN related muscle weakness are the origin of the elevated plantar pressures.

METHODS: Three groups of subjects participated: people diagnosed with diabetes without polyneuropathy (DC), people diagnosed with diabetic polyneuropathy (DPN) and healthy, age-matched controls (HC). In all subjects isometric strength of plantar and dorsal flexors was assessed. Moreover, joint moments at ankle, knee and hip joints were determined while walking barefoot at a velocity of 1.4 m/s. Simultaneously plantar pressure patterns were measured.

RESULTS: Body-mass normalized strength of dorsal flexors was significantly reduced in people with diabetes, both DC and DPN, compared to HC-subjects. Compared to HC and DC-subjects, DPN-participants walked with a reduced internal knee extensor moment and an increased internal plantar flexor moment at the first half of the stance phase. Moreover, in DPN-subjects the ratio of forefoot-to-rear foot plantar pressures was increased.

CONCLUSIONS: The results of this study suggest that adverse plantar pressure patterns are associated with redistribution of joint moments. The reduced lower leg muscle strength alone did not sufficiently explain this redistribution of joint moments and affected plantar pressure patterns.
Click to expand...

NewsBot · Oct 27, 2009

Characterizing multisegment foot kinematics during gait in diabetic foot patients.
Sawacha Z, Cristoferi G, Guarneri G, Corazza S, Dona' G, Denti P, Facchinetti A, Avogaro A, Cobelli C.
J Neuroeng Rehabil. 2009 Oct 23;6(1):37. [Epub ahead of print]

BACKGROUND: The prevalence of diabetes mellitus has reached epidemic proportions, this condition may result in multiple and chronic invalidating long term complications. Among these, the diabetic foot, is determined by the simultaneous presence of both peripheral neuropathy and vasculopathy that alter the biomechanics of the foot with the formation of callosity and ulcerations. To diagnose and treat the diabetic foot is crucial to understand the foot complex kinematics. Most of gait analysis protocols represent the entire foot as a rigid body connected to the shank. Nevertheless the existing multisegment models cannot completely decipher the impairments associated with the diabetic foot. METHODS: A four segment foot and ankle model for assessing the kinematics of the diabetic foot was developed. Ten normal subjects and 10 diabetics gait patterns were collected and major sources of variability were tested. Repeatability analysis was performed both on a normal and on a diabetic subject. Direct skin marker placement was chosen in correspondence of 13 anatomical landmarks and an optoelectronic system was used to collect the data. RESULTS: Joint rotation normative bands (mean plus/minus one standard deviation) were generated using the data of the control group. Three representative strides per subject were selected. The repeatability analysis on normal and pathological subjects results have been compared with literature and found comparable. Normal and pathological gait have been compared and showed major statistically significant differences in the forefoot and midfoot dorsi-plantarflexion. CONCLUSIONS: Even though various biomechanical models have been developed so far to study the properties and behaviour of the foot, the present study focuses on developing a methodology for the functional assessment of the foot-ankle complex and for the definition of a functional model of the diabetic neuropathic foot. It is, of course, important to evaluate the major sources of variation (true variation in the subject's gait and artefacts from the measurement procedure). The repeatability of the protocol was therefore examined, and results showed the suitability of this method both on normal and pathological subjects. Comparison between normal and pathological kinematics analysis confirmed the validity of a similar approach in order to assess neuropathics biomechanics impairment.
Click to expand...

NewsBot · Oct 6, 2010

A new classification of diabetic gait pattern based on cluster analysis of biomechanical data.
Sawacha Z, Guarneri G, Avogaro A, Cobelli C.
J Diabetes Sci Technol. 2010 Sep 1;4(5):1127-38.

BACKGROUND: The diabetic foot, one of the most serious complications of diabetes mellitus and a major risk factor for plantar ulceration, is determined mainly by peripheral neuropathy. Neuropathic patients exhibit decreased stability while standing as well as during dynamic conditions. A new methodology for diabetic gait pattern classification based on cluster analysis has been proposed that aims to identify groups of subjects with similar patterns of gait and verify if three-dimensional gait data are able to distinguish diabetic gait patterns from one of the control subjects.

METHOD: The gait of 20 nondiabetic individuals and 46 diabetes patients with and without peripheral neuropathy was analyzed [mean age 59.0 (2.9) and 61.1(4.4) years, mean body mass index (BMI) 24.0 (2.8), and 26.3 (2.0)]. K-means cluster analysis was applied to classify the subjects' gait patterns through the analysis of their ground reaction forces, joints and segments (trunk, hip, knee, ankle) angles, and moments.

RESULTS: Cluster analysis classification led to definition of four well-separated clusters: one aggregating just neuropathic subjects, one aggregating both neuropathics and non-neuropathics, one including only diabetes patients, and one including either controls or diabetic and neuropathic subjects.

CONCLUSIONS: Cluster analysis was useful in grouping subjects with similar gait patterns and provided evidence that there were subgroups that might otherwise not be observed if a group ensemble was presented for any specific variable. In particular, we observed the presence of neuropathic subjects with a gait similar to the controls and diabetes patients with a long disease duration with a gait as altered as the neuropathic one.
Click to expand...

NewsBot · Nov 19, 2012

The role of foot morphology on foot function in diabetic subjects with or without neuropathy
Annamaria Guiotto, Zimi Sawacha, Gabriella Guarneri, Giuseppe Cristoferi, Angelo Avogaro, Claudio Cobelli
Gait & Posture; Article in Press

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P<0.05), decreased contact surface on the hindfoot (P<0.03).

While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions.
Click to expand...

Highlights
► Simultaneous three-dimensional kinematics and pressure analysis of three foot's subsegments: hindfoot, midfoot, forefoot.
► Comparison between controls, diabetics non neuropathic and neuropathic subjects’ foot biomechanics.
► Foot morphology contribution to altered biomechanics.
► Data were collected during gait on 60 subjects: 20 controls and 40 diabetics.
► Statistically significant alterations on neuropathic and diabetic subjects with different foot morphology and heel/hallux alignment.
Click to expand...

Foot motion in diabetes

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Foot sole stretching and foam rolling and shoulder range of motion

The signed helical angle: A technique for characterizing midfoot motion during gait

Influence of a novel elastic foot orthosis in foot motion with mild flat foot

The functional importance of human foot muscles for bipedal locomotion

The functional importance of human foot muscles for bipedal locomotion

Assisting Foot Motion about the Pronation Axis

The functional importance of human foot muscles for bipedal locomotion

Share This Page

Foot motion in diabetes

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Foot sole stretching and foam rolling and shoulder range of motion

The signed helical angle: A technique for characterizing midfoot motion during gait

Influence of a novel elastic foot orthosis in foot motion with mild flat foot

The functional importance of human foot muscles for bipedal locomotion

The functional importance of human foot muscles for bipedal locomotion

Assisting Foot Motion about the Pronation Axis

The functional importance of human foot muscles for bipedal locomotion

Share This Page

Useful Searches