Individual metatarsal and forefoot kinematics during walking in people with diabetes mellitus and peripheral neuropathy

DiLiberto, Frank E.; Tome, Josh; Baumhauer, Judith F.; Houck, Jeff; Nawoczenski, Deborah A.

doi:10.1016/j.gaitpost.2015.07.012

Cited by 17 publications

(17 citation statements)

References 32 publications

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“…Alterations in ankle joint motion and mobility occur in relation to plantar pressure changes [ 56 ]. The range of motion at the metatarsal heads is reduced in patients with DPN when compared to that in non-diabetic patients [ 57 ]. This reduction has been found to be most prominent at the first metatarsophalangeal joint in diabetic patients with a history of ulceration [ 58 , 59 ].…”

Section: Kinematicsmentioning

confidence: 99%

Diabetic Neuropathy and Gait: A Review

et al. 2017

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Diabetic peripheral neuropathy (DPN) is a major sequela of diabetes mellitus and may have a detrimental effect on the gait of people with this complication. DPN causes a disruption in the body’s sensorimotor system and is believed to affect up to 50% of patients with diabetes mellitus, dependent on the duration of diabetes. It has a major effect on morbidity and mortality. The peripheral nervous system controls the complex series of events in gait through somatic and autonomic functions, careful balancing of eccentric and concentric muscle contractions and a reliance on the sensory information received from the plantar surface. In this literature review focussing on kinetics, kinematics and posture during gait in DPN patients, we have identified an intimate link between DPN and abnormalities in gait and demonstrated an increased risk in falls for older patients with diabetes. As such, we have identified a need for further research on the role of gait abnormalities in the development of diabetic foot ulceration and subsequent amputations.

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Section: Kinematicsmentioning

confidence: 99%

Diabetic Neuropathy and Gait: A Review

et al. 2017

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“…Studies employing multi-segment foot modeling approaches have identified changes in kinematics during walking in people with DM and DMPN and in people with DMPN with a history of ulceration 20 , 22 , 46 , 52 - 54 . Although differences in modeling approaches and study samples limit cross-study comparisons, these studies demonstrate that motion at multiple foot segments in people with DMPN is different from healthy controls.…”

Section: Advancing Clinical Guidelinesmentioning

confidence: 99%

“…Although differences in modeling approaches and study samples limit cross-study comparisons, these studies demonstrate that motion at multiple foot segments in people with DMPN is different from healthy controls. In general, there is a reduced amount of motion present at the midfoot/forefoot and metatarsophalangeal joints 19 , 20 , 52 . DiLiberto et al 20 demonstrated differences in individual metatarsal motions within the forefoot region, which may contribute to the location of elevated plantar pressures.…”

Section: Advancing Clinical Guidelinesmentioning

confidence: 99%

“…In general, there is a reduced amount of motion present at the midfoot/forefoot and metatarsophalangeal joints 19 , 20 , 52 . DiLiberto et al 20 demonstrated differences in individual metatarsal motions within the forefoot region, which may contribute to the location of elevated plantar pressures. Further, Rao et al 55 associated reductions in frontal plane calcaneus range of motion (ROM), as well as 1 st metatarsal and lateral forefoot sagittal plane ROM, during walking to elevated forefoot plantar pressures in people with DMPN.…”

Section: Advancing Clinical Guidelinesmentioning

confidence: 99%

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The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

DiLiberto

Baumhauer

Nawoczenski

2016

Braz. J. Phys. Ther.

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BackgroundImplementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload). Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines.ObjectivesThe first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration.DiscussionResearch demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes.ConclusionContinued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus.

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“…Bacarin et al controlled cadence [7], Yavuzer et al used a fast (1.4 m/s) speed [8], which can be challenging for DPN subjects, and DiLiberto et al used a slow (0.9 m/s) speed [9, 10]. Gait speed can greatly affect joint mechanics [11]; for example, findings of decreased joint ranges of motion [8, 9, 12] in DPN during self-selected walking speeds are consistent with what would be expected simply by walking more slowly [11, 13]. Without speed controls, it is difficult to separate the influences of DPN on joint mechanics from those due to speed alone.…”

Section: Introductionmentioning

confidence: 99%

Diabetic Gait Is Not Just Slow Gait: Gait Compensations in Diabetic Neuropathy

Henderson

Johnson

Ridge

et al. 2019

Journal of Diabetes Research

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Background Neuropathic complications from diabetes mellitus affect multiple nerve types and may manifest in gait. However, gait compensations are still poorly understood, as narrow analyses and lack of speed controls have contributed to conflicting or equivocal results. Purpose To evaluate gait mechanics and energetics in diabetic peripheral polyneuropathy. Methods Instrumented gait analysis was performed on 14 participants with diabetic peripheral polyneuropathy and 14 matched controls, walking at 1.0 m/s. A full-body model with a multisegment foot was used to calculate inverse dynamics and analyze sagittal plane metrics and time series waveforms across stance phase. Results Alterations included increased hip and knee flexion in early stance followed by a prolonged hip extension moment in midstance. Late stance ankle dorsiflexion and power absorption were increased, and final push-off was delayed and truncated. Conclusion A neuropathic diabetic gait shares important similarities to a mild crouch gait with weakness/dysfunction in the foot and ankle. This study highlights two main compensation mechanisms that have been overlooked in previous literature. First, increased triceps surae stretch in terminal stance may be used to increase proprioception and/or energy storage, while a prolonged hip extension moment in midstance compensates for a limited push-off. These result in an overall workload shift from distal to proximal joints. Clinical assessment, monitoring, and treatment of neuropathy may benefit by focusing on these specific functional alterations.

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Individual metatarsal and forefoot kinematics during walking in people with diabetes mellitus and peripheral neuropathy

Cited by 17 publications

References 32 publications

Diabetic Neuropathy and Gait: A Review

Diabetic Neuropathy and Gait: A Review

The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

Diabetic Gait Is Not Just Slow Gait: Gait Compensations in Diabetic Neuropathy

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