The purpose of our study was to examine dynamic foot function during gait as it relates to plantar loading in individuals with DM (diabetes mellitus and neuropathy) compared to matched control subjects. Foot mobility during gait was examined using a multi-segment kinematic model, and plantar loading was measured using a pedobarograph in subjects with DM (N=15), control subjects (N=15). Pearson product moment correlation was used to assess the relationship between variables of interest. Statistical significance and equality of correlations were assessed using approximate tests based on Fisher’s Z transformation (α=0.05). In individuals with DM, 1st metatarsal sagittal plane excursion during gait was negatively associated with pressure time integral under the medial forefoot (r = −0.42 and −0.06, DM and Ctrl, P= 0.02). Similarly, lateral forefoot sagittal plane excursion during gait was negatively associated with pressure time integral under the lateral forefoot (r = −0.56 and −0.11, DM and Ctrl, P = 0.02). Frontal plane excursion of the calcaneus was negatively associated with medial (r= −0.57 and 0.12, DM and Ctrl, P < 0.01) and lateral (r= −0.51 and 0.13, DM and Ctrl, P < 0.01) heel and medial forefoot pressure time integral (r= −0.56 and −0.02, DM and Ctrl, P < 0.01). The key findings of our study indicate that reductions in segmental foot mobility were accompanied by increases in local loading in subjects with DM. Reduction in frontal plane calcaneal mobility during walking serves as an important functional marker of loss of foot flexibility in subjects with DM.

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.

*Use of the full-length (FL) insert was accompanied by decreased duration of loading in the midfoot (P .05) and equivocal changes in duration of loading at the heel and forefoot. Error bars indicate standard deviation.

Introduction-The purpose of our study was to examine the relationship between ankle dorsiflexion (DF) range of motion (ROM) and stiffness measured at rest (passively) and plantar loading during gait in individuals with and without diabetes mellitus (DM) and sensory neuropathy. Specifically, we sought to address three questions for this at-risk patient population: (1) Does peak passive DF ROM predict ankle DF ROM used during gait? (2) Does passive ankle stiffness predict ankle stiffness used during gait? (3) Are any of the passive or gait-related ankle measures associated with plantar loading?Methods-Ten subjects with DM and 10 age and gender matched non-diabetic control subjects participated in this study. Passive ankle DF ROM and stiffness were measured with the Iowa Ankle ROM device. Kinematic, kinetic and plantar pressure data were collected as subjects walked at 0.89 m/s.Results-We found that subjects with DM have reduced passive ankle DF ROM and increased stiffness compared to non-diabetic control subjects, however, subjects with DM demonstrated ankle motion, stiffness and plantar pressures, similar to control subjects, while walking at the identical speed, 0.89 m/s (2 mph). These data indicate that clinical measures of heel cord tightness and stiffness do not represent ankle motion or stiffness utilized during gait. Our findings suggest that subjects with DM utilize strategies such as shortening their stride length and reducing their push-off power to modulate plantar loading.

The purpose of our study was to examine 1st metatarsophalangeal (MTP) joint motion and flexibility and plantar loads in individuals with high, normal and low arch foot structure. Asymptomatic individuals (n=61), with high, normal and low arches participated in this study. Foot structure was quantified using malleolar valgus index (MVI) and arch height index (AHI). First MTP joint flexibility was measured using a specially constructed jig. Peak pressure under the hallux, 1st and 2nd metatarsals during walking was assessed using a pedobarograph. A one-way ANOVA with Bonferroni-adjusted post-hoc comparisons was used to assess between-group differences in MVI, AHI, Early and Late 1st MTP joint flexibility in sitting and standing, peak dorsiflexion (DF), and peak pressure under the hallux, 1st and 2nd metatarsals. Stepwise linear regression was used to identify predictors of hallucal loading. Significant between-group differences were found in MVI (F2,56=15.4, p<0.01), 1st MTP late flexibility in sitting (F2,57=3.7, p=0.03), and standing (F2,57=3.7, p=0.03). Post-hoc comparisons demonstrated that 1st MTP late flexibility in sitting was significantly higher in individuals with low arch compared to high arch structure, and that 1st MTP late flexibility in standing was significantly higher in individuals with low arch compared to normal arch structure. Stepwise regression analysis indicated that MVI and 1st MTP joint early flexibility in sitting explain about 20% of the variance in hallucal peak pressure. Our results provide objective evidence indicating that individuals with low arches show increased 1st MTP joint late flexibility compared to individuals with normal arch structure, and that hindfoot alignment and 1st MTP joint flexibility affect hallucal loading.