Analysis of the interplay between proximal lower limb and foot joint structures as a mechanical predictor of neuropathic ulceration

• Published in: Gait & posture 2024-10, Vol.114, p.250-256
• Main Authors: Bartolo, Erica, Giacomozzi, Claudia, Coppini, David V., Gatt, Alfred
• Format: Article
• Language: English
• Subjects: Adult; Aged; Ankle Joint - physiopathology; Biomechanical Phenomena; Cross-Sectional Studies; Diabetic Foot - physiopathology; Diabetic Neuropathies - physiopathology; Diabetic peripheral neuropathy; Female; Foot joint kinematics; Foot Joints - physiopathology; Gait Analysis; Humans; Lower Extremity - physiopathology; Lower limb joint kinematics; Male; Middle Aged; Neuropathic ulceration; Prospective Studies; Three-dimensional gait analysis
• ISSN: 0966-6362; 1879-2219; 1879-2219
• DOI: 10.1016/j.gaitpost.2024.10.015

Diabetes-related foot ulcers are a leading cause of morbidity and mortality globally, in which the most significant contributing factor is peripheral neuropathy. The purpose of this research was to evaluate the influence of diabetic peripheral neuropathy and ulceration on lower limb and foot joint kinematics during gait. Are there any significant alterations lower limb and foot joint kinematics during gait in the presence of active and history of diabetic neuropathic ulceration? A prospective, cross-sectional study was conducted, recruiting eighty adult participants who were equally divided into four groups, namely, the diabetes (DM), diabetic peripheral neuropathy (DPN), active diabetic neuropathic ulceration (DNU) and history of diabetic neuropathic ulceration (DHNU) groups. Three-dimensional gait analysis was performed, and participants were instructed to walk barefoot over a 10-m walkway at self-selected speed. The acquired pelvic, hip, knee, ankle and foot joint segmental kinematic data was compared between individuals with and without active neuropathic ulceration. Mean scores between the four independent groups was performed using the Kruskal-Wallis test. Participants within the DNU and DHNU groups demonstrated significantly reduced knee flexion, ankle dorsiflexion and first metatarsal dorsiflexion kinematics with resultant increased anterior pelvic tilt, hip flexion and midtarsal kinematics (all values p