Limits...
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.

Show MeSH

Related in: MedlinePlus

Fore-aft component of the ground reaction force for health elderly (black lines), people with diabetes without polyneuropathy (dark grey lines) and people with diabetic polyneuropathy (light gray lines). Graphs represent averages values for each group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2654541&req=5

Figure 3: Fore-aft component of the ground reaction force for health elderly (black lines), people with diabetes without polyneuropathy (dark grey lines) and people with diabetic polyneuropathy (light gray lines). Graphs represent averages values for each group.

Mentions: The body-mass-normalized braking force differed between groups (p = 0.041); Figure 3), with a lower braking force in DPN than in diabetic and healthy subjects. Also the maximal propelling force was significantly smaller in DPN than in both other groups (p-0.012; Figure 3). The vertical component of the GRF did not differ between the groups.


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)

Fore-aft component of the ground reaction force for health elderly (black lines), people with diabetes without polyneuropathy (dark grey lines) and people with diabetic polyneuropathy (light gray lines). Graphs represent averages values for each group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Fore-aft component of the ground reaction force for health elderly (black lines), people with diabetes without polyneuropathy (dark grey lines) and people with diabetic polyneuropathy (light gray lines). Graphs represent averages values for each group.
Mentions: The body-mass-normalized braking force differed between groups (p = 0.041); Figure 3), with a lower braking force in DPN than in diabetic and healthy subjects. Also the maximal propelling force was significantly smaller in DPN than in both other groups (p-0.012; Figure 3). The vertical component of the GRF did not differ between the groups.

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