Redistribution of Joint Moments is Associated with Changed Plantar Pressure in Diabetic Polyneuropathy

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2009 Feb 5

PMID 19192272

Citations 12

Authors

Hans H C M Savelberg

Nicolaas C Schaper

Paul J B Willems

Ton L H de Lange

Kenneth Meijer

Affiliations

Soon will be listed here.

Abstract

Background: Patients with diabetic polyneuropathy (DPN) are often confronted with ulceration of foot soles. Increased plantar pressure under the forefoot has been identified as a major risk factor for ulceration. This study sets out to test the hypothesis that changes in gait characteristics induced by DPN related muscle weakness are the origin of the elevated plantar pressures.

Methods: Three groups of subjects participated: people diagnosed with diabetes without polyneuropathy (DC), people diagnosed with diabetic polyneuropathy (DPN) and healthy, age-matched controls (HC). In all subjects isometric strength of plantar and dorsal flexors was assessed. Moreover, joint moments at ankle, knee and hip joints were determined while walking barefoot at a velocity of 1.4 m/s. Simultaneously plantar pressure patterns were measured.

Results: Compared to HC-subjects, DPN-participants walked with a significantly increased internal plantar flexor moment at the first half of the stance phase. Also in DPN-subjects the maximal braking and propelling force applied to the floor was decreased. Moreover, in DPN-subjects the ratio of forefoot-to-rear foot plantar pressures was increased. Body-mass normalized strength of dorsal flexors showed a trend to be reduced in people with diabetes, both DC and DPN, compared to HC-subjects. Plantar flexors tended to be less weak in DC compared to HC and in DPN relative to DC.

Conclusion: The results of this study suggest that adverse plantar pressure patterns are associated with redistribution of joint moments, and a consequent reduced capacity to control forward velocity at heel strike.

Citing Articles

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Diabetic Gait Is Not Just Slow Gait: Gait Compensations in Diabetic Neuropathy.

Henderson A, Wayne Johnson A, Ridge S, Egbert J, Curtis K, Berry L J Diabetes Res. 2019; 2019:4512501.

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Alam U, Riley D, Jugdey R, Azmi S, Rajbhandari S, DAout K Diabetes Ther. 2017; 8(6):1253-1264.

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The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors.

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