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Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy.

Savelberg HH, Schaper NC, Willems PJ, de Lange TL, Meijer K - BMC Musculoskelet Disord (2009)

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Human Movement Science, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. hans.savelberg@bw.unimaas.nl

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.

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Related in: MedlinePlus

Maximal, voluntary, isometric strength of plantar and dorsal flexor muscle groups for health elderly (black bars), people with diabetes without polyneuropathy (dark grey bars) and people with diabetic polyneuropathy (light grey bars). Muscle strength is expressed as the joint moment exerted in a dynamometer normalized for body mass (Nm/kg). Bars represent mean values for a group; standard deviations are presented as vertical lines.
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Figure 2: Maximal, voluntary, isometric strength of plantar and dorsal flexor muscle groups for health elderly (black bars), people with diabetes without polyneuropathy (dark grey bars) and people with diabetic polyneuropathy (light grey bars). Muscle strength is expressed as the joint moment exerted in a dynamometer normalized for body mass (Nm/kg). Bars represent mean values for a group; standard deviations are presented as vertical lines.

Mentions: Body-mass-normalized dorsal flexor moment tended to be lower in both diabetic groups compared to healthy controls (p = 0.128). The average normalized dorsal flexor moments were 0.57, 0.47 and 0.47 Nm/kg (HC, DC and DPN). For normalized plantar flexion strength a non-significant trend (p = 0.153) was observed: 1.07, 0.83 and 0.58 Nm/kg in the HC, DC and DPN patients, respectively (Figure 2). Absolute strength of plantar flexors (HC: 78.2 ± 46.6 Nm; DC: 66.7 ± 53.5 Nm; DPN: 50.3 ± 28.6 Nm) and of dorsal flexors did not differ between groups (HC: 40.8 ± 11.0 Nm; DC: 38.1 ± 15.4 Nm; DPN: 39.5 ± 8.2 Nm).


Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy.

Savelberg HH, Schaper NC, Willems PJ, de Lange TL, Meijer K - BMC Musculoskelet Disord (2009)

Maximal, voluntary, isometric strength of plantar and dorsal flexor muscle groups for health elderly (black bars), people with diabetes without polyneuropathy (dark grey bars) and people with diabetic polyneuropathy (light grey bars). Muscle strength is expressed as the joint moment exerted in a dynamometer normalized for body mass (Nm/kg). Bars represent mean values for a group; standard deviations are presented as vertical lines.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2654541&req=5

Figure 2: Maximal, voluntary, isometric strength of plantar and dorsal flexor muscle groups for health elderly (black bars), people with diabetes without polyneuropathy (dark grey bars) and people with diabetic polyneuropathy (light grey bars). Muscle strength is expressed as the joint moment exerted in a dynamometer normalized for body mass (Nm/kg). Bars represent mean values for a group; standard deviations are presented as vertical lines.
Mentions: Body-mass-normalized dorsal flexor moment tended to be lower in both diabetic groups compared to healthy controls (p = 0.128). The average normalized dorsal flexor moments were 0.57, 0.47 and 0.47 Nm/kg (HC, DC and DPN). For normalized plantar flexion strength a non-significant trend (p = 0.153) was observed: 1.07, 0.83 and 0.58 Nm/kg in the HC, DC and DPN patients, respectively (Figure 2). Absolute strength of plantar flexors (HC: 78.2 ± 46.6 Nm; DC: 66.7 ± 53.5 Nm; DPN: 50.3 ± 28.6 Nm) and of dorsal flexors did not differ between groups (HC: 40.8 ± 11.0 Nm; DC: 38.1 ± 15.4 Nm; DPN: 39.5 ± 8.2 Nm).

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Human Movement Science, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. hans.savelberg@bw.unimaas.nl

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.

Show MeSH
Related in: MedlinePlus