Walking Strategy in Diabetic Patients With Peripheral Neuropathy

Giacomozzi, Claudia; Caselli, Antonella; Macellari, Velio; Giurato, Laura; Lardieri, Lina; Uccioli, Luigi

doi:10.2337/diacare.25.8.1451

Cited by 108 publications

(103 citation statements)

References 23 publications

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“…The study and control groups did not differ in height indicating that height did not confound stride length findings. Our results are in agreement with previous reports in which shorter stride lengths were accompanied by a decrease in the forward excursion of the center of pressure [32] as well as reduced ankle moment and power [27,29]. Reduced plantar flexor moment and reduced power at push off have also been described in subjects with DM as an attempt to provide the major positive work at push-off using their hip flexors [26].…”

Section: Discussionsupporting

confidence: 93%

Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy

2006

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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.

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Section: Discussionsupporting

confidence: 93%

Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy

2006

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“…1). The observed reduction of plantarflexion between the Sha-Cal during FFPOP in the PwDM_NP reflects a deviant third rocker and is probably related to the above mentioned 'cautious walking strategy' (Giacomozzi et al, 2002). Kerrigan et al (1998) observed a similar reduction in ankle plantarflexion in elderly subjects and inferred it as an adaptive strategy to maintain greater foot-to-floor contact during terminal stance.…”

Section: Discussionmentioning

confidence: 61%

“…A delayed heel off was detected in this group (P = 0.021). A more conservative walking strategy can be considered as a plausible explanation, as this is characterized by a less prominent propulsive phase (Giacomozzi et al, 2002). This assumption can be further underpinned by the fact that the FFPOP was significantly shorter in the PwDM_NP group (Additional file 1).…”

Section: Discussionmentioning

confidence: 99%

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

Deschamps

Matricali

Roosen

et al. 2013

Clinical Biomechanics

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Background: Reduction in foot mobility has been identified as a key factor of altered foot biomechanics in individuals with diabetes mellitus. This study aimed at comparing in vivo segmental foot kinematics and coupling in patients with diabetes with and without neuropathy to control adults. Methods: Foot mobility of 13 diabetic patients with neuropathy, 13 diabetic patients without neuropathy and 13 non-diabetic persons was measured using an integrated measurement set-up including a plantar pressure platform and 3D motion analysis system. In this age-, sex-and walking speed matched comparative study; differences in range of motion quantified with the Rizzoli multisegment foot model throughout different phases of the gait cycle were analysed using one-way repeated measures analysis of variance (ANOVA). Coupling was assessed with cross-correlation techniques. Findings: Both cohorts with diabetes showed significantly lower motion values as compared to the control group. Transverse and sagittal plane motion was predominantly affected with often lower range of motion values found in the group with neuropathy compared to the diabetes group without neuropathy. Most significant changes were observed during propulsion (both diabetic groups) and swing phase (predominantly diabetic neuropathic group). A trend of lower cross-correlations between segments was observed in the cohorts with diabetes. Interpretation: Our findings suggest an alteration in segmental kinematics and coupling during walking in diabetic patients with and without neuropathy. Future studies should integrate other biomechanical measurements as it is believed to provide additional insight into neural and mechanical deficits associated to the foot in diabetes.

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“…These structural and functional changes have been recognized as responsible for increased plantar pressures (7,20) . In a previous study, we observed that significant changes in forefoot GRF components may be present in diabetic patients without neuropathy (21), thus suggesting that other modifications, independent from peripheral neuropathy, may occur.…”

Section: Discussionmentioning

confidence: 99%

Contribution of Plantar Fascia to the Increased Forefoot Pressures in Diabetic Patients

et al. 2003

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OBJECTIVES -Secondary to peripheral neuropathy, plantar hyperpressure is a proven risk factor for foot ulceration. But limited joint mobility (LJM) and soft tissue abnormalities may also contribute. The aim of this study was to evaluate the relationships among thickness of plantar fascia, mobility of the metatarso-phalangeal joint, and forces expressed under the metatarsal heads.RESEARCH DESIGN AND METHODS -We evaluated 61 diabetic patients: 27 without neuropathy (D group), 19 with neuropathy (DN group), and 15 with previous neuropathic foot ulceration (DNPU group). We also examined 21 control subjects (C). Ultrasound evaluation was performed with a high resolution 8-to 10-MHz linear array (Toshiba Tosbee SSA 240). The foot loading pattern was evaluated with a piezo-dynamometric platform. First metatarsophalangeal joint mobility was assessed with a mechanic goniometer.RESULTS -Diabetic patients presented increased thickness of plantar fascia (D 2.9 Ϯ 1.2 mm, DN 3.0 Ϯ 0.8 mm, DNPU 3.1 Ϯ 1.0 mm, and C 2.0 Ϯ 0.5.mm; P Ͻ 0.05), and significantly reduced motion range at the metatarso-phalangeal joint (D 54.0 Ϯ 29.4°, DN 54.9 Ϯ 17.2°, DNPU 46.8 Ϯ 20.7°, and C 100.0 Ϯ 10.0°; P Ͻ 0.05). The evaluation of foot-floor interaction under the metatarsal heads showed increased vertical forces in DN and DNPU and increased medio-lateral forces in DNPU. An inverse correlation was found between the thickness of plantar fascia and metatarso-phalangeal joint mobility (r ϭ Ϫ0.53). The thickness of plantar fascia was directly correlated with vertical forces under the metatarsal heads (r ϭ 0.52).CONCLUSIONS -In diabetic patients, soft tissue involvement may contribute to the increase of vertical forces under the metatarsal heads. Changes in the structure of plantar fascia may also influence the mobility of the first metatarso-phalangeal joint. Diabetes Care 26:1525-1529, 2003I n diabetic patients, peripheral neuropathy induces foot deformities and changes in the walking pattern that are responsible for the development of areas of high plantar pressure (1-3).Mechanical stress has been recognized to have a central pathogenic role in the onset of diabetic neuropathic ulcers (4). Among the factors that may contribute to increase mechanical stress, limited joint mobility (LJM) of the ankle joint is associated with increased peak forefoot pressures, and therefore with risk of ulceration (5,6). Atrophy and weakness of tibialis anterior and vastus lateralis muscles as well as atrophy of the intrinsic muscles have been recognized to induce important changes in the performance of the ankle movements and in the biomechanical properties of the diabetic neuropathic foot (3). Another well-known cause of increased forefoot pressure is the increased thickness of the Achilles tendon; the efficacy of its surgical lengthening on forefoot pressure release has been investigated and reported in literature, even if the results still show some discrepancies (7,8). Structural changes in the forefoot of diabetic neuropathic patients, in terms of bone and muscle...

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Walking Strategy in Diabetic Patients With Peripheral Neuropathy

Cited by 108 publications

References 23 publications

Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy

Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy

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

Contribution of Plantar Fascia to the Increased Forefoot Pressures in Diabetic Patients

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