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Gait parameters of people with diabetes-related neuropathic plantar foot ulcers

  • Malindu Eranga Fernando
    Correspondence
    Corresponding author at: Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland 4814, Australia.
    Affiliations
    Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia

    Movement Analysis Laboratory, Sport and Exercise, James Cook University, Townsville, Queensland, Australia

    Podiatry Service, Kirwan Community Health Campus, Townsville Hospital & Health Service, Townsville, Queensland, Australia
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  • Robert G. Crowther
    Affiliations
    Movement Analysis Laboratory, Sport and Exercise, James Cook University, Townsville, Queensland, Australia

    Sport and Exercise, School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia
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  • Peter A. Lazzarini
    Affiliations
    Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia

    School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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  • Kunwarjit S. Sangla
    Affiliations
    Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia
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  • Petra Buttner
    Affiliations
    Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
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  • Jonathan Golledge
    Affiliations
    Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia

    Department of Vascular and Endovascular Surgery, The Townsville Hospital, Queensland, Australia
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      Highlights

      • This was a novel prospective investigation of lower limb gait characteristics in cases with active foot ulcers.
      • The cases had several different kinematic, kinetic and spatial characteristics compared to controls.
      • Whether these characteristics have any integral relationship to ulcer healing is unknown
      • The gait abnormalities found in this study will be longitudinally monitored

      Abstract

      Background

      Foot ulceration associated with diabetic peripheral neuropathy is a global concern. Biomechanical investigation allows the identification of gait abnormalities that may adversely affect ulcer healing. The objective of this case–control study was to compare the gait parameters of cases with diabetes-related foot ulcers to controls.

      Methods

      Three-dimensional movement analyses were performed on 21 people with diabetes-related neuropathic plantar foot ulcers (cases), 69 people with diabetes without a foot ulcer history (diabetes controls) and 56 healthy controls. Outcome data were reported as mean differences, 95% confidence intervals and Cohen's d effect sizes. Binary logistic regressions were used to adjust for age, sex and body mass index.

      Findings

      People with foot ulcers had a smaller plantar flexion (Cohen's d = −0.6 vs. diabetes controls and d = −0.8 vs. healthy controls), knee flexion (d = −0.6 vs. diabetes controls and d = −1.0 vs. healthy controls) and pelvic obliquity (d = −0.9 vs. diabetes controls and d = −0.7 vs. healthy controls) (all P < 0.05). They also had a significantly greater range of anterior–posterior ground reaction force (d = 1.0 vs. diabetes controls and d = 1.7 vs. healthy controls) and total vertical ground reaction force (d = 0.9 vs. diabetes controls and d = 1.1 vs. healthy controls) and significantly slower walking speed and smaller step length compared to controls (all P < 0.05).

      Interpretation

      People with plantar foot ulcers have considerably different gait parameters to controls. Whether the observed gait parameters contributed to the ulcer development or are a response to the ulcer is currently unclear and needs further investigation.

      Abbreviations:

      DFU (Diabetes related foot ulcer), DPN (Diabetic peripheral neuropathy), PAD (Peripheral arterial disease), ABPI (Ankle brachial pressure index), PTI (Pressure time integral), ROM (Range of motion), UTWCS (University of Texas Wound Classification System)

      Keywords

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