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Decoding foot deformity and joint-destruction pathways in diabetes: Emerging insights from in-vivo foot joint kinetic measures

  • Kevin Deschamps
    Correspondence
    Corresponding author at: Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Spoorwegstraat 12, 8200 Brugge, Belgium.
    Affiliations
    KU Leuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Tervuursevest 101, 3001 Heverlee, Belgium
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  • Filip Staes
    Affiliations
    KU Leuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Tervuursevest 101, 3001 Heverlee, Belgium
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  • Frank Nobels
    Affiliations
    Department of Internal Medicine-Endocrinology, Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouw Ziekenhuis Aalst, Moorselbaan 164, 9300 Aalst, Belgium
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  • Sicco A. Bus
    Affiliations
    Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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  • David G. Armstrong
    Affiliations
    Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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  • Giovanni Matricali
    Affiliations
    Department of Development and Regeneration, KULeuven, Leuven, Belgium

    Member Institute of Orthopaedic Research & Training (IORT), Leuven, Belgium
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      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

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