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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2009

Open Access 01-12-2009 | Research article

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

Authors: Hans HCM Savelberg, Nicolaas C Schaper, Paul JB Willems, Ton LH de Lange, Kenneth Meijer

Published in: BMC Musculoskeletal Disorders | Issue 1/2009

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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.
Appendix
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Metadata
Title
Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy
Authors
Hans HCM Savelberg
Nicolaas C Schaper
Paul JB Willems
Ton LH de Lange
Kenneth Meijer
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2009
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-10-16

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