Gait in people with nonhealing diabetes-related plantar ulcers

Fernando, Malindu E., Crowther, Robert G., Lazzarini, Peter A., Sangla, Kunwarjit S., Wearing, Scott, Buttner, Petra, and Golledge, Jonathan (2019) Gait in people with nonhealing diabetes-related plantar ulcers. Physical therapy, 99 (12). pp. 1602-1615.

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Abstract

BACKGROUND: Abnormalities in gait have been associated with high plantar pressures and diabetes-related plantar foot ulcers. Whether these are a transient response to the ulcer or are representative of long-term lower limb biomechanical abnormalities is currently unknown.

OBJECTIVE: The aim of this study was to examine whether 12 gait parameters identified as being associated with nonhealing diabetes-related plantar foot ulcers at baseline remained associated during a 6-month follow-up period.

DESIGN: This was a longitudinal observational case-control study.

METHODS: Gait assessments were performed at entry and twice during follow-up over a 6-month period in 12 participants with nonhealing diabetes-related plantar foot ulcers (case participants) and 62 people with diabetes and no history of foot ulcers (control participants) using a standardized protocol. Linear mixed-effects random-intercept models were used to identify gait parameters that consistently differed between case participants and control participants at all assessments after adjustment for age, sex, body mass index, presence of peripheral neuropathy, and follow-up time. Standardized mean differences (SMD) were used to measure effect sizes.

RESULTS: Five of the 12 gait parameters were significantly different between case participants and control participants at all 3 time points. Case participants had a more abducted foot progression angle (SMD = 0.37), a higher pelvic obliquity at toe-off (SMD = -0.46), a greater minimum pelvic obliquity (SMD = -0.52), a lower walking speed (SMD = -0.46), and a smaller step length (SMD = -0.46) than control participants.

LIMITATIONS: The limitations included a small sample size, the observational nature of the study, and the inability to evaluate the impact of gait on wound healing.

CONCLUSIONS: This study identified abnormal gait parameters consistently associated with nonhealing diabetes-related plantar foot ulcers. Further research is needed to test the clinical importance of these gait characteristics.

Item ID: 61636
Item Type: Article (Research - C1)
ISSN: 1538-6724
Copyright Information: © 2019 American Physical Therapy Association.
Funders: Queensland Government (QG), James Cook University (JCU), National Health and Medical Research Council (NHMRC)
Projects and Grants: QG Health Practitioner Research Grant Scheme 2013–2014, JCU Graduate Research School, JCU The Ulcer and Wound HEALing Consortium (UHEAL), NHMRC 1117061, QG Senior Clinical Research Fellowship, JCU Australian Postgraduate Award Scholarship, JCU College of Medicine scholarship
Date Deposited: 25 Feb 2020 02:27
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1102 Cardiovascular Medicine and Haematology > 110299 Cardiovascular Medicine and Haematology not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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