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

Fernando, Malindu Eranga, Crowther, Robert G., Lazzarini, Peter A., Sangla, Kunwarjit S., Buttner, Petra, and Golledge, Jonathan (2016) Gait parameters of people with diabetes-related neuropathic plantar foot ulcers. Clinical Biomechanics, 37. pp. 98-107.

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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.

Item ID: 45955
Item Type: Article (Research - C1)
ISSN: 1879-1271
Keywords: diabetic foot disease, biomechanics, plantar ulcers, peripheral diabetic neuropathy, foot ulceration, gait
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A version of this publication was included as Chapter 6 of the following PhD thesis: Fernando, Malindu Eranga (2017) The gait features & plantar pressures of people with diabetic peripheral neuropathy & plantar foot ulcers. PhD thesis, James Cook University, which is available Open Access in ResearchOnline@JCU. Please see the Related URLs for access.

Funders: Queensland Department of Health, Health Practitioner Research Grant Scheme, James Cook University, National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC 1019921
Date Deposited: 05 Oct 2016 07:53
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
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