Williams D S Blaise, Brunt Denis, Tanenberg Robert J
Department of Physical Therapy, East Carolina University, Greenville, NC, USA.
J Appl Biomech. 2007 Nov;23(4):251-60. doi: 10.1123/jab.23.4.251.
The majority of plantar ulcers in the diabetic population occur in the forefoot. Peripheral neuropathy has been related to the occurrence of ulcers. Long-term diabetes results in the joints becoming passively stiffer. This static stiffness may translate to dynamic joint stiffness in the lower extremities during gait. Therefore, the purpose of this investigation was to demonstrate differences in ankle and knee joint stiffness between diabetic individuals with and without peripheral neuropathy during gait. Diabetic subjects with and without peripheral neuropathy were compared. Subjects were monitored during normal walking with three-dimensional motion analysis and a force plate. Neuropathic subjects had higher ankle stiffness (0.236 N.m/deg) during 65 to 80% of stance when compared with non-neuropathic subjects (-0.113 N.m/deg). Neuropathic subjects showed a different pattern in ankle stiffness compared with non-neuropathic subjects. Neuropathic subjects demonstrated a consistent level of ankle stiffness, whereas non-neuropathic subjects showed varying levels of stiffness. Neuropathic subjects demonstrated lower knee stiffness (0.015 N.m/deg) compared with non-neuropathic subjects (0.075 N.m/deg) during 50 to 65% of stance. The differences in patterns of ankle and knee joint stiffness between groups appear to be related to changes in timing of peak ankle dorsiflexion during stance, with the neuropathic group reaching peak dorsiflexion later than the non-neuropathic subjects. This may partially relate to the changes in plantar pressures beneath the metatarsal heads present in individuals with neuropathy.
糖尿病患者的足底溃疡大多发生在前足。周围神经病变与溃疡的发生有关。长期糖尿病会导致关节被动僵硬。这种静态僵硬可能会在步态中转化为下肢的动态关节僵硬。因此，本研究的目的是证明在步态过程中，有和没有周围神经病变的糖尿病个体在踝关节和膝关节僵硬程度上的差异。对有和没有周围神经病变的糖尿病受试者进行了比较。在正常行走过程中，使用三维运动分析和测力板对受试者进行监测。与无神经病变的受试者（-0.113N·m/度）相比，神经病变受试者在站立65%至80%期间的踝关节僵硬程度更高（0.236N·m/度）。与无神经病变的受试者相比，神经病变受试者的踝关节僵硬模式有所不同。神经病变受试者的踝关节僵硬程度保持一致，而无神经病变的受试者则表现出不同程度的僵硬。在站立50%至65%期间，与无神经病变的受试者（0.075N·m/度）相比，神经病变受试者的膝关节僵硬程度较低（0.015N·m/度）。两组之间踝关节和膝关节僵硬模式的差异似乎与站立期间踝关节背屈峰值时间的变化有关，神经病变组达到背屈峰值的时间比无神经病变的受试者晚。这可能部分与神经病变个体中跖骨头下方足底压力的变化有关。
