Avaliação das perdas sensório-motoras do pé e tornozelo decorrentes da neuropatia diabética

Abstract

Objective: To identify motor sensory deficits in the feet of neuropathic diabetic patients and compare their deficits with a group of healthy subjects. Method: 49 neuropathic diabetics (group NG) and 22 controls (group CG) underwent a three-stage protocol: (1) an interview using a questionnaire to characterize the neuropathy and symptoms; (2) assessment of muscle function and range of motion, and functional tests on the feet and ankles; (3) assessment of tactile and thermal sensitivity. The groups were compared using the chi-squared, Mann-Whitney and Student t tests (p< 0.05). Results: NG presented significant losses of tactile and thermal sensitivity in comparison with CG, especially in the heels (49.0% of NG and 97.3% of CG). Muscle function was decreased in NG, with predominance of loss of grade 5. The muscles most affected were the interossei (23.4%), extensor hallucis (42.5%) and triceps surae (43.2%), while all muscle function was preserved in CG. All ranges of motion in NG were reduced in comparison with CG. The functional tests on the ankles in NG presented a decrease of around 50%. Conclusion: There were significant differences between the groups with regard to sensitivity, muscle function, range of motion and functional losses. These differences can be attributed to the diabetic neuropathy.

Comprometimento sensório-motor dos membros inferiores em diabéticos do tipo 2

“…Um dos fatores que predispõem o aparecimento da neuropatia periférica é o valor glicêmico alto, assim como sua flutuação (7,32). Havia na população estudada indivíduos que não faziam o controle adequado da glicemia, o que reflete diretamente nos resultados obtidos pelo Sistema de Pontuação Clínica de Toronto e monofilamento de Semmes-Weinstein.…”

Vasculopathy associated with peripheral neuropathy in gait parameters of diabetic people

“…When associated with vascular impairment of the lower limbs, this generates a set of changes in the feet, characterized as diabetic foot 2 . Over the course of the disease, there may be deformations, decreased mobility, and muscle hypotrophism of the foot and ankle, resulting in changes in plantar pressure and thus predisposing the individual to the development of ulcers and the risk of falls [3][4][5][6] . This, added to deficits in the motor control system, intensifies the imbalances and alterations in posture and gait 3 .…”

“…Over the course of the disease, there may be deformations, decreased mobility, and muscle hypotrophism of the foot and ankle, resulting in changes in plantar pressure and thus predisposing the individual to the development of ulcers and the risk of falls [3][4][5][6] . This, added to deficits in the motor control system, intensifies the imbalances and alterations in posture and gait 3 . Investigations in this population indicate a reduction in gait velocity and step length increasing the duration of the support phase, a decrease in the mobility of the ankle joint, a redistribution of joint moments, and changes in kinematic lower limb and muscle activation, compared with the normal range of subjects without diabetes [7][8][9][10] .…”

Distribuição Da Pressão Plantar Na Postura Estática De Diabéticos

“…Quando um desses fatores está comprometido, como na NDP, contribui para a diminuição do equilíbrio, alterações posturais e compromete a funcionalidade e independências do indivíduo (5).…”