Diabetic neuropathy and lower limb stiffness

NewsBot · Jan 16, 2008

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Diabetic neuropathy is related to joint stiffness during late stance phase.
Williams DS 3rd, Brunt D, Tanenberg RJ.
J Appl Biomech. 2007 Nov;23(4):251-60.

The majority of plantar ulcers in the diabetic population occur in the forefoot. Peripheral neuropathy has been related to the occurrence of ulcers. Long-term diabetes results in the joints becoming passively stiffer. This static stiffness may translate to dynamic joint stiffness in the lower extremities during gait. Therefore, the purpose of this investigation was to demonstrate differences in ankle and knee joint stiffness between diabetic individuals with and without peripheral neuropathy during gait. Diabetic subjects with and without peripheral neuropathy were compared. Subjects were monitored during normal walking with three-dimensional motion analysis and a force plate. Neuropathic subjects had higher ankle stiffness (0.236 N.m/deg) during 65 to 80% of stance when compared with non-neuropathic subjects (-0.113 N.m/deg). Neuropathic subjects showed a different pattern in ankle stiffness compared with non-neuropathic subjects. Neuropathic subjects demonstrated a consistent level of ankle stiffness, whereas non-neuropathic subjects showed varying levels of stiffness. Neuropathic subjects demonstrated lower knee stiffness (0.015 N.m/deg) compared with non-neuropathic subjects (0.075 N.m/deg) during 50 to 65% of stance. The differences in patterns of ankle and knee joint stiffness between groups appear to be related to changes in timing of peak ankle dorsiflexion during stance, with the neuropathic group reaching peak dorsiflexion later than the non-neuropathic subjects. This may partially relate to the changes in plantar pressures beneath the metatarsal heads present in individuals with neuropathy.
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Admin2 · Jan 16, 2008

Related thread:
Plantar feedback contributes to the regulation of leg stiffness

NewsBot · Jul 10, 2010

A comparison of lower limb EMG and ground reaction forces between barefoot and shod gait in participants with diabetic neuropathic and healthy controls
Isabel CN Sacco, Paula MH Akashi and Ewald M Hennig
BMC Musculoskeletal Disorders 2010, 11:24doi:10.1186/1471-2474-11-24

Background
It is known that when barefoot, gait biomechanics of diabetic neuropathic patients differ from non-diabetic individuals. However, it is still unknown whether these biomechanical changes are also present during shod gait which is clinically advised for these patients. This study investigated the effect of the participants own shoes on gait biomechanics in diabetic neuropathic individuals compared to barefoot gait patterns and healthy controls.

Methods
Ground reaction forces and lower limb EMG activities were analyzed in 21 non-diabetic adults (50.9 ± 7.3 yr, 24.3 ± 2.6 kg/m2) and 24 diabetic neuropathic participants (55.2 ± 7.9 yr, 27.0 ± 4.4 kg/m2). EMG patterns of vastus lateralis, lateral gastrocnemius and tibialis anterior, along with the vertical and antero-posterior ground reaction forces were studied during shod and barefoot gait.

Results
Regardless of the disease, walking with shoes promoted an increase in the first peak vertical force and the peak horizontal propulsive force. Diabetic individuals had a delay in the lateral gastrocnemius EMG activity with no delay in the vastus lateralis. They also demonstrated a higher peak horizontal braking force walking with shoes compared to barefoot. Diabetic participants also had a smaller second peak vertical force in shod gait and a delay in the vastus lateralis EMG activity in barefoot gait compared to controls.

Conclusions
The change in plantar sensory information that occurs when wearing shoes revealed a different motor strategy in diabetic individuals. Walking with shoes did not attenuate vertical forces in either group. Though changes in motor strategy were apparent, the biomechanical did not support the argument that the use of shoes contributes to altered motor responses during gait.
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NewsBot · Feb 9, 2020

Stiffness of Intrinsic Foot Structures in Diabetic Individuals and the Effect of Stiffness on Plantar Pressures During Gait
Bell, Erica A
Thesis

Plantar foot ulcers are a severe and common complication associated with diabetes that overwhelmingly lead to non-traumatic major amputations among diabetic individuals. There are several known factors that contribute to the development of these ulcers, however it is possible that stiffening of foot structures (i.e. muscles, tendons, ligaments) is another important factor that has yet to be fully investigated. Increased soft tissue stiffness on the plantar surface of the foot has been found in diabetic individuals, but stiffness of individual foot structures has yet to be investigated. It has been proposed in literature that stiffening of muscles and tendons in diabetic feet cause increased plantar pressures, which often precede development of ulcers. However, to date, no study has comprehensively examined stiffness of individual foot structures in diabetic individuals and the effect of stiffness on plantar pressures during gait. Therefore, the ultimate purpose of the following work was to investigate the relationship between foot structure stiffness and plantar pressures during gait in diabetic individuals. Firstly, it was hypothesized that stiffness of foot structures would be directly and linearly related to plantar pressures during gait. Secondly, it was hypothesized that diabetics would exhibit higher stiffness and higher plantar pressures than controls. There is also evidence of structural changes in the diabetic foot compared to controls, including thickening of the plantar fascia (PF) and Achilles tendon. Plantar fasciitis is a common musculoskeletal disorder that, like diabetes, is associated with thickening of the PF. To date, few studies have investigated material properties of the PF, and there are currently no studies that have assessed material properties of other arch supporting structures (i.e. muscles, tendons) . It is possible that, in addition to thickening of the PF, plantar fasciitis populations exhibit material property changes of the PF and other arch supporting structures that contribute to the plantar fasciitis injury mechanism. Investigating material properties of the PF and arch supporting structures and how these properties relate to plantar pressures in individuals with plantar fasciitis may help provide relevant information to injury development in the foot in plantar fasciitis and diabetic populations. Therefore, material properties of foot structures and plantar pressures during gait were also assessed in individuals with plantar fasciitis. First, it was hypothesized that individuals with active plantar fasciitis symptoms would exhibit altered stiffness of foot structures compared to controls and individuals with a history of plantar fasciitis who are currently asymptomatic. Secondly, it was hypothesized that stiffness of PF stiffness would inversely and linearly relate to plantar pressures during gait in individuals with plantar fasciitis. The studies herein provide evidence that: 1) relationships are present between individual foot structures and plantar pressures in diabetic individuals and; 2) individual foot structures exhibited higher stiffness in diabetic individuals for some, but not all examined foot structures compared to controls. Contrary to the primary hypothesis, the observed relationships were mostly negative, suggesting that lower stiffness of individual foot structures relates to higher pressure. There is evidence that individuals with plantar fasciitis exhibit structural property changes similar to those observed in diabetic individuals, thus material properties of foot structures and their relationships with plantar pressures were also assessed in this population. Interestingly, individuals with plantar fasciitis exhibited mostly positive relationships, which was also contrary to the hypothesis for that population. Although some differential relationships existed within these groups, the diabetic and plantar fasciitis population displayed similar values for proximal plantar fascia stiffness that was negatively correlated with peak pressure under the heel. Structurally, diabetic individuals and individuals with plantar fasciitis similarly displayed decreased thickness of muscles and tendons which is suggestive of weakening and/or damage occurring to these structures. Taken together, these results support the idea of foot structure stiffness relating to plantar pressures and more specifically, are suggestive of damage occurring to the plantar fascia that is directly influencing plantar pressure distributions and foot function in diabetic individuals and individuals with plantar fasciitis. Thus, stiffness may still be an important factor to consider in understanding alterations of foot function and potentially in the ulcer injury mechanism in diabetic individuals.
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Diabetic neuropathy and lower limb stiffness

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Admin2 Administrator Staff Member

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Share This Page

Diabetic neuropathy and lower limb stiffness

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.

Non-diabetic, painless Peripheral Neuropathy Both Feet, Lower legs

Vincamine ameliorates diabetic peripheral neuropathy in mice

Verrucous Skin Lesions on the Feet in Diabetic Neuropathy

Capsaicin for painful diabetic neuropathy

Foot Surgery without Anesthesia in Diabetic Patients with Sensory Neuropathy

Warm salt water foot-bath for painful diabetic peripheral neuropathy

Barefoot with diabetic neuropathy - Illustrated.

Share This Page

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