Article

Biomechanical alterations in diabetes are believed to contribute to plantar
neuropathic ulceration. This exploratory study documents clinical measures of
flexibility and strength, alongside three-dimensional biomechanical gait data of
the lower limb, in 10 patients with a history of neuropathic ulceration (DNU;
n=10). Comparative data is presented from age and gender matched groups with;
diabetes peripheral neuropathy and no ulcer history (DWN; n=10), diabetes and no
peripheral neuropathy (DNN; n=10) and a non-diabetes reference group (NOND;
n=10). Biomechanical data were collected at a comfortable walking speed with a
Vicon motion analysis system. Clinical measures showed a non-significant trend
toward decreased static range of motion at the ankle and first
metatarsophalangeal joints, with worsening neuropathy status. Of the diabetes
groups, knee and ankle strength was significantly lower in those with an ulcer
history (p=0.01-0.03), with the exception of knee extension. In the DNU group,
walking speed was on average 0.17 ms slower compared to NOND (p=0.04). The DNU
group demonstrated a lower range of motion than NOND at the: hips (frontal plane,
by 25%: p=0.03); hips and knees (transverse plane, 31%: p=0.01 and 32%: p<0.01);
ankles (sagittal plane, 22%: p<0.01) and first metatarsophalangeal joints
(sagittal plane, 32%: p=0.01), with less foot rotation (24%: p=0.04). Kinetic
alterations in DNU included lower: ankle maximum power (21%: p=0.03) and vertical
ground reaction force 2nd peak (6%: p<0.01). The study findings identified gait
alterations in people with clinically severe peripheral neuropathy and related
plantar foot ulcer history. Further research is needed to explore potential casual pathways.
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