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Type 2 diabetes mellitus and obesity: The synergistic effects on human locomotor function

      Highlights

      • Diabetic-obese patients presented worse spatio-temporal parameters of gait.
      • Sagittal plane kinematics showed altered ankle plantarflexion during push-off time.
      • Knee and hip kinematics revealed a reduced peak flexion during the swing time.
      • Diabetic-obese subjects present gait features typical of both these conditions.
      • Results highlight a synergistic effect of such pathologies on human motion strategy.

      Abstract

      Background

      Diabetes Mellitus and obesity represent two chronic multifactorial conditions which may induce modifications in human motion strategy. Our study focused on gaining insight into biomechanical aspects of gait occurring in patients affected by both aforementioned pathologies.

      Methods

      One hundred subjects were recruited and divided into four groups: 25 obese-diabetic patients with peripheral neuropathy; 25 obese non-diabetic patients; 25 non-obese diabetic patients with peripheral neuropathy; 25 healthy volunteers participated as a control group. Subjects performed 3-D Gait Analysis while walking barefoot at self-selected speed, performing three consecutive trials. A multivariate analysis of variance test was used to assess spatio-temporal and kinematic data difference in the four groups. Tukey's post-hoc adjustment was applied on multiple groups' comparison.

      Findings

      Diabetic-obese subjects showed increased step width compared to controls, while step and stride length, and walking velocity were reduced. Interestingly, step width presented increased values even compared to diabetic patients. Kinematics data showed a significant reduction in ankle plantarflexion during the push-off phase of the gait cycle compared to controls, and to obese subjects. Furthermore, knee kinematics revealed a reduced peak flexion during the swing time of the gait cycle, compared to controls and diabetic subjects, which resulted in reduced knee dynamic excursion during normal walking compared to healthy subjects.

      Interpretation

      Our data demonstrated that diabetic-obese subjects present gait features typical of both such pathologies. The specific impairment of ankle and knee joint kinematics provides evidence of a synergistic effect of Diabetes Mellitus type 2 and obesity on human ambulatory function.

      Keywords

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      References

        • Allet L.
        • Armand S.
        • Golay A.
        • Monnin D.
        • De Bie R.A.
        • De Bruin E.D.
        Gait characteristics of diabetic patients: a systematic review.
        Diabetes Metab. Res. Rev. 2008; 24: 173-191
        • Andersen H.
        • Gadeberg P.C.
        • Brock B.
        • Jakobsen J.
        Muscular atrophy in diabetic neuropathy stereological magnetic resonance imaging study.
        Diabetologia. 1997; 40: 1062
        • Armstrong D.G.
        • Boulton A.J.M.
        • Bus S.A.
        Diabetic foot ulcers and their recurrence.
        N. Engl. J. Med. 2017; 376: 2367-2375
        • Butterworth P.
        • Urquhart D.
        • Landorf K.
        • Wluka A.
        • Cicuttini F.
        • Menz H.
        Foot posture, range of motion and plantar pressure characteristics in obese and non-obese individuals.
        Gait Posture. 2015; 41: 465-469
        • Campanini I.
        • Merlo A.
        • Damiano B.
        A method to differentiate the causes of stiff-knee gait in stroke patients.
        Gait Posture. 2013; 38: 165-169
        • Davis R.B.
        • Ounpuu S.
        • Tyburski D.
        • Gage J.R.
        A gait analysis data collection and reduction technique.
        Hum. Mov. Sci. 1991; 5: 575-587
        • De Souza S.A.F.
        • Faintuch J.
        • Valezi A.C.
        • Sant’ Anna A.F.
        • Gama-Rodrigues J.J.
        • de Batista Fonseca I.C.
        • Buro Souza R.
        • Senhorini R.C.
        Gait cinematic analysis in morbidly obese patients.
        Obes. Surg. 2005; 15: 1238-1242
        • De Vita P.
        • Hortoba’gyi T.
        Obesity is not associated with increased knee joint torque and power during level walking.
        J. Biomech. 2003; 36: 1355-1362
        • Dingwell J.B.
        • Cusumano J.P.
        • Sternad D.
        • Cavanagh P.R.
        Slower speeds in patients with diabetic neuropathy lead to improved local dynamic stability of continuous overground walking.
        J. Biomech. 2000; 33: 1269-1277
        • Ducic I.
        • Short K.W.
        • Dellon A.L.
        Relationship between loss of pedal sensibility, balance, and falls in patients with peripheral neuropathy.
        Ann. Plast. Surg. 2004; 52: 535-540
        • Hausdorff J.M.
        • Rios D.A.
        • Edelberg H.K.
        Gait variability and fall risk in community-living older adults: a 1-year prospective study.
        Arch. Phys. Med. Rehabil. 2001; 82: 1050-1056
        • Hills A.P.
        • Henning E.M.
        • Byrne N.M.
        • et al.
        The biomechanics of adiposity – structural and functional limitations of obesity and implications for movement.
        Obes. Rev. 2002; 3: 35-43
        • International Diabetes Federation (IDF)
        DIABETES ATLAS Ninth Edition.
        2019
        • Kathirgamanathan B.
        • Silva P.
        • Fernandez J.
        Implication of obesity on motion, posture and internal stress of the foot: an experimental and finite element analysis.
        Comp. Methods Biomech. Biomed. Eng. 2018; 1-9
        • Kerrigan D.C.
        • Lee L.W.
        • Collins J.J.
        • Riley P.O.
        • Lipsitz L.A.
        Reduced hip extension during walking: healthy elderly and fallers versus young adults.
        Arch. Phys. Med. Rehabil. 2001; 82: 26-30
        • Ko S.
        • Stenholm S.
        • Chia C.W.
        • Simonsick E.M.
        • Ferrucci Luigi
        Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy—results from the Baltimore longitudinal study of aging.
        Gait Posture. 2011; 34: 548-552
        • Lai P.P.K.
        • Leung A.K.L.
        • Li A.N.M.
        • Zhang M.
        Three-dimensional gait analysis of obese adults.
        Clin. Biomech. 2008; 23: S2-S6
        • Lamola G.
        • Venturi M.
        • Martelli D.
        • Iacopi E.
        • Fanciullacci C.
        • Coppelli A.
        • Rossi B.
        • Piaggesi A.
        • Chisari C.
        Quantitative assessment of early biomechanical modifications in diabetic foot patients: the role of foot kinematics and step width.
        J. NeuroEng. Rehabil. 2015; 12: 98
        • Menz H.B.
        • Lord S.R.
        • St George R.
        • Fitzpatrick R.C.
        Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy.
        Arch. Phys. Med. Rehabil. 2004; 85: 245-252
        • Mueller M.J.
        • Minor S.D.
        • Sahrmann S.A.
        • Schaaf J.A.
        • Strube M.J.
        Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls.
        Phys. Ther. 1994; 74: 299-313
        • Park W.
        • Ramachandran J.
        • Weisman P.
        • Jung E.S.
        Obesity effect on male active joint range of motion.
        Ergonomics. 2010; 53: 102-108
        • Perry J.
        Analisi del Cammino.
        Edizione Elsevier, 2005
        • Petrofsky J.
        • Lee S.
        • Bweir S.
        Gait characteristics in people with type 2 diabetes mellitus.
        Eur. J. Appl. Physiol. 2005; 93: 640-647
        • Piaggesi A.
        • Romanelli M.
        • Schipani E.
        • Campi F.
        • Magliaro A.
        • Baccetti F.
        • Navalesi R.
        Hardness of plantar skin in diabetic neuropathic feet.
        J. Diabetes Complicat. 1999; 13: 129-134
        • Ranavolo A.
        • Donini L.M.
        • Mari S.
        • Serrao M.
        • Silvetti A.
        • Iavicoli S.
        • Cava E.
        • Asprino R.
        • Pinto A.
        • Draicchio F.
        Lower-limb joint coordination pattern in obese subjects. BioMed. Research.
        International. 2013; : 1-9
        • Rao S.
        • Saltzman C.
        • Yack H.
        Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy.
        Gait Posture. 2006; 24: 295-301
        • Raspovic A.
        Gait characteristics of people with diabetes-related peripheral neuropathy, with and without a history of ulceration.
        Gait Posture. 2013; 38: 723-728
        • Sawacha Z.
        • Guarneri G.
        • Cristoferi G.
        • Guiotto A.
        • Avogaro A.
        • Cobelli C.
        Diabetic gait and posture abnormalities: a biomechanical investigation through three dimensional gait analysis.
        Clin. Biomech. 2009; 24: 722-728
        • Tomlinson D.J.
        • Erskine R.M.
        • Morse C.I.
        • Winwood K.
        • Onambélé-Pearson G.
        The impact of obesity on skeletal muscle strength and structure through adolescence to old age.
        Biogerontology. 2015; 17: 467-483
        • Tramonti C.
        • Di Martino S.
        • Chisari C.
        An intensive task-oriented circuit training positively impacts gait biomechanics in MS patients.
        NeuroRehabilitation. 2020; 46: 321-331
        • Wrobel J.S.
        • Najafi B.
        Diabetic foot biomechanics and gait dysfunction.
        J. Diabetes Sci. Technol. 2010; 4: 1-13
        • Zurales K.
        • DeMott T.K.
        • Kim H.
        • Allet L.
        • Ashton-Miller J.A.
        • Richardson J.K.
        Gait efficiency on an uneven surface is associated with falls and injury in older subjects with a spectrum of lower limb neuromuscular function: a prospective study.
        Am. J. Phys. Med. Rehabil. 2016; 95: 83-90