Comparison of foot segmental mobility and coupling during gait between patients with diabetes mellitus with and without neuropathy and adults without diabetes

Deschamps, Kevin; Matricali, Giovanni; Roosen, Philip; Nobels, Frank; Tits, Jos; Desloovere, Kaat; Bruyninckx, Herman; Flour, Mieke; Verhoeven, W.M.A.; Staes, Filip

doi:10.1016/j.clinbiomech.2013.06.008

Cited by 35 publications

(21 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This reduction in joint motion is more pronounced in diabetic patients with peripheral neuropathy, and has been observed during the propulsive and swing stages of gait [15] . Alterations in foot biomechanics and balance issues secondary to peripheral neuropathy are important factors which could lead to ground level falls and trauma (Table 2).…”

Section: Disturbances Of Gaitmentioning

confidence: 96%

See 1 more Smart Citation

Diabetes and its negative impact on outcomes in orthopaedic surgery

Wukich

2015

WJO

110

103

View full text Add to dashboard Cite

An estimated 285 million adults (aged 20-79 years) worldwide were diagnosed to have diabetes mellitus (DM) in 2010, and this number is projected to grow to 439 million adults by the year 2030. Orthopaedic surgeons, regardless of their subspecialty interest, will encounter patients with DM during their career since this epidemic involves both developed and emerging countries. Diabetes results in complications affecting multiple organ systems, potentially resulting in adverse outcomes after orthopaedic surgery. The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients. Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle, upper extremity, adult reconstructive, pediatrics, spine surgery and sports medicine. Poorly controlled diabetes negatively impacts bone, soft tissue, ligament and tendon healing. It is the complications of diabetes such as neuropathy, peripheral artery disease, and end stage renal disease which contributes to adverse outcomes. Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes. Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.

show abstract

Section: Disturbances Of Gaitmentioning

confidence: 96%

“…Patients with DM often have limitation of motion in the foot and ankle, resulting in biomechanical abnormalities [15] . This reduction in joint motion is more pronounced in diabetic patients with peripheral neuropathy, and has been observed during the propulsive and swing stages of gait [15] .…”

Section: Disturbances Of Gaitmentioning

confidence: 99%

Diabetes and its negative impact on outcomes in orthopaedic surgery

Wukich

2015

WJO

110

103

View full text Add to dashboard Cite

show abstract

“…Turner et al [6], using the same modified Oxford multi-segmental foot model used in this study, also report no difference in hindfoot relative to shank excursion between those with and without diabetes and foot complications. However, Deschamp et al [24] and Rao et al [25], using slightly different foot models, report a reduction in hindfoot relative to shank excursion during walking in those with DMPN compared to healthy controls. Past work using single segment foot models have been similarly inconsistent when examining motion between the foot segment and the shank [26–30].…”

Section: Discussionmentioning

confidence: 99%

“…However, it is our hypothesis that kinematic analysis of walking, particularly at slow walking speeds (around 1 m/s), may not be a task that is consistently sensitive to changes associated with chronic diabetes. Total sagittal plane excursion of the foot segment relative to the shank across studies is surprisingly similar, most within a range of 15° to 20° [6,24,28], and group differences range from 2° to 7° [6,24,25]. Future study would benefit from inclusion of kinematic analysis of tasks that are more challenging and clearly and consistently measure deficits associated with complications from chronic diabetes.…”

Section: Discussionmentioning

confidence: 99%

Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity

et al. 2014

View full text Add to dashboard Cite

Diabetic foot deformity onset and progression maybe associated with abnormal foot and ankle motion. The modified Oxford multi-segmental foot model allows kinematic assessment of inter-segmental foot motion. However, there are insufficient anatomical landmarks to accurately representation the alignment of the hindfoot and forefoot segments during model construction. This is most notable for the sagittal plane which is referenced parallel to the floor, allowing comparison of inter-segmental excursion but not capturing important sagittal hind-to-forefoot deformity associated with diabetic foot disease and can potentially underestimate true kinematic differences. The purpose of the study was to compare walking kinematics using local coordinate systems derived from the modified Oxford model and the radiographic directed model which incorporated individual calcaneal and 1st metatarsal declination pitch angles for the hindfoot and forefoot. We studied twelve participants in each of the following groups: (1) diabetes mellitus, peripheral neuropathy and medial column foot deformity (DMPN+), (2) DMPN without medial column deformity (DMPN−) and (3) age- and weight-match controls. The modified Oxford model coordinate system did not identify differences between groups in the initial, peak, final, or excursion hindfoot relative to shank or forefoot relative to hindfoot dorsiflexion/plantarflexion during walking. The radiographic coordinate system identified the DMPN+ group to have an initial, peak and final position of the forefoot relative to hindfoot that was more dorsiflexed (lower arch phenotype) than the DMPN− group (p < .05). Use of radiographic alignment in kinematic modeling of those with foot deformity reveals segmental motion occurring upon alignment indicative of a lower arch.

show abstract

“…(Deschamps et al 2013;Hastings et al 2014;Rao et al 2007;Sawacha et al 2009;Turner et al 2007) The inconsistency in measuring differences in inter-segmental foot motion and ankle power during walking may be, in part, related to weaker expression of kinematic abnormalities during the walking task. Walking is a general lower extremity task, allowing compensation by the hip and knee for foot limitations.…”

Section: Introductionmentioning

confidence: 99%

Kinematics and kinetics of single-limb heel rise in diabetes related medial column foot deformity

Hastings

Woodburn

Mueller

et al. 2014

Clinical Biomechanics

View full text Add to dashboard Cite

Background Diabetes-related medial column foot deformities contribute to high plantar pressure, joint instability, ulceration and amputation. Impaired foot function may be an early indicator of foot structural incompetence and contribute to deformity progression. This study examines the ability of single-limb heel rise multi-segmental kinematics and kinetics to identify midfoot and hindfoot dysfunction in those with diabetes-related medial column foot deformity. Methods Single-limb heel rise foot kinematics and kinetics were examined in adults with diabetes mellitus and peripheral neuropathy with and without medial column foot deformity and age-, weight-matched controls. Findings Hindfoot relative to shank plantarflexion, peak and excursion, were reduced in bothdiabetes groups compared to controls (P<0.017). Controls' initial forefoot relative to hindfoot position was plantarflexed 31 degrees and plantarflexed an additional 13 degrees during heel rise. The initial forefoot relative to hindfoot position for the diabetes group without deformity was similarly plantarflexed as controls (34 degrees) while the diabetes deformity group was less plantarflexed (lower arch position: 23 degrees, P<0.017). During the heel rise task both diabetes groups demonstrated less ability to plantarflex the forefoot relative to the hindfoot compared to controls (2 and 5 degrees respectively, P<0.017). Ankle plantarflexion power was reduced in the diabetes deformity group compared to controls (P<0.017). Interpretation The single-limb heel rise task identified movement dysfunction in those with diabetes mellitus and peripheral neuropathy. Failure to plantarflex the forefoot relative to hindfoot may compromise midfoot joint stability and increase the risk of injury and arch collapse.

show abstract

Comparison of foot segmental mobility and coupling during gait between patients with diabetes mellitus with and without neuropathy and adults without diabetes

Cited by 35 publications

References 39 publications

Diabetes and its negative impact on outcomes in orthopaedic surgery

Diabetes and its negative impact on outcomes in orthopaedic surgery

Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity

Kinematics and kinetics of single-limb heel rise in diabetes related medial column foot deformity

Contact Info

Product

Resources

About