Association between ankle equinus and plantar pressures in people with diabetes. A systematic review and meta-analysis

Abstract

Limited ankle joint dorsiflexion may be an important factor in elevating plantar pressures, independent of neuropathy. Limited ankle dorsiflexion and increased plantar pressures were found in all the studies where the sample population had a history of neuropathic foot ulceration. In contrast, the same association was not found in those studies where the population had neuropathy and no history of foot ulcer. Routine screening for limited ankle dorsiflexion range of motion in the diabetic population would allow for early provision of conservative treatment options to reduce plantar pressures and lessen ulcer risk.

Effect of a HIIT protocol on the lower limb muscle power, ankle dorsiflexion and dynamic balance in a sedentary type 1 diabetes mellitus population: a pilot study

“…This improvement is interesting because of a proper dorsiflexion range of motion is crucial to allow a correct functionality in daily living activities (Medeiros & Martini, 2018) and a very important factor in rehabilitation gait and for improved walking, particularly in clinical population (Embrey et al, 2010). It is also important to reduce the 12-25% risk that people with diabetes have to developing foot ulcers (Searle et al, 2017). It is possible to indicate that HIIT performed in cycle ergometer may be beneficial and an interesting tool for maintaining in non-impairment functionality in T1DM people.…”

“…This condition has been demonstrated to compromise skeletal muscle function, even beginning early in life in many cases, what would indicate that muscle dysfunction is a primary diabetic complication (being more accelerated with the development of neuropathy) (Krause, Riddell & Hawke, 2011;Monaco, Gingrich & Hawke, 2019). Hyperglycemia also promotes the increase in ankle stiffness even without the presence of neuropathy (Francia et al, 2018;Searle et al, 2017;Searle, Spink & Chuter, 2018) and compromises dynamic balance, also in young patients with no complications diagnosed (Katsarou et al, 2017;Kukidome et al, 2017;Turcot et al, 2009), among other physiological complications. Because of that, T1DM causes the premature loss of lower limb strength (Celes et al, 2017;Monaco, Gingrich & Hawke, 2019), functional capacities such dynamic balance (even in adults <50 years old) (Camargo et al, 2015;D'Silva et al, 2016;Kukidome et al, 2017) and joint mobility in comparison with their healthy counterparts (Rao et al, 2006).…”

“…Because of that, T1DM causes the premature loss of lower limb strength (Celes et al, 2017;Monaco, Gingrich & Hawke, 2019), functional capacities such dynamic balance (even in adults <50 years old) (Camargo et al, 2015;D'Silva et al, 2016;Kukidome et al, 2017) and joint mobility in comparison with their healthy counterparts (Rao et al, 2006). In T1DM population, low strength is related to functional limitations (Lopez et al, 2018;Papa, Dong & Hassan, 2017), ankle stiffness has been implicated as a potential factor of overload of the forefoot during the stance phase of the gait due to the reduced dorsiflexion capacity, which result in foot ulcers (Rao et al, 2006;Searle et al, 2017). Moreover, the increased postural sway caused by the pathology disorders increases the risk of falling (D' Silva et al, 2016;Kukidome et al, 2017).…”

Peer Review #1 of "Effect of a HIIT protocol on the lower limb muscle power, ankle dorsiflexion and dynamic balance in a sedentary type 1 diabetes mellitus population: a pilot study (v0.1)"

“…This condition has been demonstrated to compromise skeletal muscle function, even beginning early in life in many cases, what would indicate that muscle dysfunction is a primary diabetic complication (being more accelerated with the development of neuropathy) (Krause et al, 2011;Monaco et al, 2019). Hyperglycemia also promotes the increase in ankle stiffness even without the presence of neuropathy (Francia et al, 2018;Searle et al, 2017Searle et al, , 2018 and compromises dynamic balance, also in young patients with no complications diagnosed (Katsarou et al, 2017;Kukidome et al, 2017;Turcot et al, 2009), among other physiological complications. Because of that, T1DM causes the premature loss of lower limb strength (Celes et al, 2017;Monaco et al, 2019), PeerJ reviewing PDF | (2020:05:48640:2:1:NEW 6 Nov 2020)…”

Validation of a weight bearing ankle equinus value in older adults with diabetes

“…However, there are limited data available for comparison of the general population [ 8 , 10 , 11 , 15 , 16 ] or for populations with diabetes [ 17 – 19 ]. Additionally, while authors have variously defined a non-WB equinus as < 0 degrees, 0 degrees or less, < 5 degrees or < 10 degrees of ankle dorsiflexion [ 20 ], there is currently no recognised degree of WB ankle dorsiflexion restriction that indicates a restricted or pathological range. Baumbach et al [ 15 ] have recently suggested that dorsiflexion less than 30 degrees, a value that fell below the 95% CI in the young healthy adult cohort they measured, should be regarded as restricted.…”