Highlights
- •Persons with diabetes mellitus had decreased sagittal angular velocity throughout foot segments.
- •Decreased angular velocity contributed to reduced midtarsal power generation.
- •Persons with diabetic neuropathy tend to acquire an energy neutral foot.
Abstract
Background
A comprehensive insight into the effect of longstanding diabetes mellitus and neuropathy
on foot joint kinetics during walking is lacking. Our goal was to assess the in-vivo
kinetics of major foot joints in persons with diabetes.
Methods
Three groups, matched for age, sex and walking speed were recruited in this study:
1) people with diabetic peripheral neuropathy, 2) people with diabetes without peripheral
neuropathy, and 3) control subjects without diabetes. Participants were instrumented
with retroreflective markers on both feet and lower limbs and underwent a barefoot
gait analysis using a state-of-the-art multi-segment kinetic foot modelling approach
in order to provide accurate joint loading measures at the ankle, midtarsal, tarso-metatarsal
and hallux joints.
Findings
The group with neuropathy showed reduced ankle peak plantarflexion angular velocity
compared to the control group (P = 0.002). Both groups with diabetes showed a significantly reduced midtarsal peak
plantarflexion angular velocity, peak power generation and positive work compared
to the control group (p < 0.01). Groups showed significant differences with respect to the tarsometatarsal
peak dorsiflexion (p = 0.006) and plantarflexion angular velocity (P < 0.05).
Interpretation
This study shows that both diabetes groups have similar joint loading and power absorption
capacity but seem to lose their power generation capacity especially at the midtarsal
joint. This loss of power generation capacity and the resulting decreased net mechanical
work of the foot potentially embodies a foot that poorly supplements the body's mechanical
energy during push-off. This phenomenon may cause excessive tissue stresses that contribute
to foot deformity and joint-destruction mechanisms.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical BiomechanicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diabetic foot ulcers and their recurrence.N. Engl. J. Med. 2017; 15: 2367-2375
- Estimation of foot joint kinetics in three and four segment foot models using an existing proportionality scheme: application in paediatric barefoot walking.J. Biomech. 2017; 61: 168-175https://doi.org/10.1016/j.jbiomech.2017.07.017
- Estimation of foot joint kinetics in three and four segment foot models using an existing proportionality scheme: application in paediatric barefoot walking.J. Biomech. 2017; 61: 168-175https://doi.org/10.1016/j.jbiomech.2017.07.017
- Clinical applicability of an existing proportionality scheme in three-segment kinetic foot models.Ann. Biomed. Eng. 2019; 48: 247-257https://doi.org/10.1007/s10439-019-02344-8
- Loss of mechanical ankle function is not compensated by the distal foot joints in patients with ankle osteoarthritis.Clin. Orthop. Relat. Res. 2021; 1: 105-115
- Rear-foot, mid-foot and fore-foot motion during the stance phase of gait.Gait Posture. 2007; 25: 453-462https://doi.org/10.1016/j.gaitpost.2006.05.017
- ISB recommendations for skin-marker-based multi-segment foot kinematics.J. Biomech. 2021; 125110581https://doi.org/10.1016/j.jbiomech.2021.110581
- The Charcot foot in diabetes.Diabetes Care. 2011; 34: 2123-2129https://doi.org/10.2337/dc11-0844
- Diabetic foot biomechanics and gait dysfunction.J. Diabetes Sci. Technol. 2010; 4: 833-845
Article info
Publication history
Published online: October 19, 2022
Accepted:
October 17,
2022
Received:
July 28,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
