Malindu Eranga Fernando1, Robert G Crowther2, Peter A Lazzarini3, Kunwarjit S Sangla4, Petra Buttner5, Jonathan Golledge6. 1. Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Movement Analysis Laboratory, Sport and Exercise, James Cook University, Townsville, Queensland, Australia; Podiatry Service, Kirwan Community Health Campus, Townsville Hospital & Health Service, Townsville, Queensland, Australia. Electronic address: malindu.fernando@my.jcu.edu.au. 2. Movement Analysis Laboratory, Sport and Exercise, James Cook University, Townsville, Queensland, Australia; Sport and Exercise, School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia. 3. Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia. 4. Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia. 5. Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia. 6. Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Queensland, Australia.
Abstract
BACKGROUND: Foot ulceration associated with diabetic peripheral neuropathy is a global concern. Biomechanical investigation allows the identification of gait abnormalities that may adversely affect ulcer healing. The objective of this case-control study was to compare the gait parameters of cases with diabetes-related foot ulcers to controls. METHODS: Three-dimensional movement analyses were performed on 21 people with diabetes-related neuropathic plantar foot ulcers (cases), 69 people with diabetes without a foot ulcer history (diabetes controls) and 56 healthy controls. Outcome data were reported as mean differences, 95% confidence intervals and Cohen's d effect sizes. Binary logistic regressions were used to adjust for age, sex and body mass index. FINDINGS: People with foot ulcers had a smaller plantar flexion (Cohen's d=-0.6 vs. diabetes controls and d=-0.8 vs. healthy controls), knee flexion (d=-0.6 vs. diabetes controls and d=-1.0 vs. healthy controls) and pelvic obliquity (d=-0.9 vs. diabetes controls and d=-0.7 vs. healthy controls) (all P<0.05). They also had a significantly greater range of anterior-posterior ground reaction force (d=1.0 vs. diabetes controls and d=1.7 vs. healthy controls) and total vertical ground reaction force (d=0.9 vs. diabetes controls and d=1.1 vs. healthy controls) and significantly slower walking speed and smaller step length compared to controls (all P<0.05). INTERPRETATION: People with plantar foot ulcers have considerably different gait parameters to controls. Whether the observed gait parameters contributed to the ulcer development or are a response to the ulcer is currently unclear and needs further investigation.
BACKGROUND: Foot ulceration associated with diabetic peripheral neuropathy is a global concern. Biomechanical investigation allows the identification of gait abnormalities that may adversely affect ulcer healing. The objective of this case-control study was to compare the gait parameters of cases with diabetes-related foot ulcers to controls. METHODS: Three-dimensional movement analyses were performed on 21 people with diabetes-related neuropathic plantar foot ulcers (cases), 69 people with diabetes without a foot ulcer history (diabetes controls) and 56 healthy controls. Outcome data were reported as mean differences, 95% confidence intervals and Cohen's d effect sizes. Binary logistic regressions were used to adjust for age, sex and body mass index. FINDINGS:People with foot ulcers had a smaller plantar flexion (Cohen's d=-0.6 vs. diabetes controls and d=-0.8 vs. healthy controls), knee flexion (d=-0.6 vs. diabetes controls and d=-1.0 vs. healthy controls) and pelvic obliquity (d=-0.9 vs. diabetes controls and d=-0.7 vs. healthy controls) (all P<0.05). They also had a significantly greater range of anterior-posterior ground reaction force (d=1.0 vs. diabetes controls and d=1.7 vs. healthy controls) and total vertical ground reaction force (d=0.9 vs. diabetes controls and d=1.1 vs. healthy controls) and significantly slower walking speed and smaller step length compared to controls (all P<0.05). INTERPRETATION:People with plantar foot ulcers have considerably different gait parameters to controls. Whether the observed gait parameters contributed to the ulcer development or are a response to the ulcer is currently unclear and needs further investigation.
Authors: Malindu E Fernando; Robert G Crowther; Peter A Lazzarini; Kunwarjit S Sangla; Scott Wearing; Petra Buttner; Jonathan Golledge Journal: J Diabetes Sci Technol Date: 2019-06-16
Authors: Peter A Lazzarini; Ryan T Crews; Jaap J van Netten; Sicco A Bus; Malindu E Fernando; Paul J Chadwick; Bijan Najafi Journal: J Diabetes Sci Technol Date: 2019-04-29
Authors: Malindu E Fernando; Robert G Crowther; Peter A Lazzarini; Kunwarjit S Sangla; Scott Wearing; Petra Buttner; Jonathan Golledge Journal: BMC Endocr Disord Date: 2016-09-15 Impact factor: 2.763
Authors: Malindu E Fernando; Robert G Crowther; Peter A Lazzarini; Saiumaeswar Yogakanthi; Kunwarjit S Sangla; Petra Buttner; Rhondda Jones; Jonathan Golledge Journal: PLoS One Date: 2017-08-31 Impact factor: 3.240
Authors: Katie E Chatwin; Caroline A Abbott; Andrew J M Boulton; Frank L Bowling; Neil D Reeves Journal: Diabetes Metab Res Rev Date: 2019-12-11 Impact factor: 4.876