Department of Podiatry and Lower Extremity Gait Studies Program, School of Allied Health, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria 3086, Australia.
Gait Posture. 2013 Sep;38(4):723-8. doi: 10.1016/j.gaitpost.2013.03.009. Epub 2013 Apr 11.
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.
人们认为糖尿病引起的生物力学改变会导致足底神经性溃疡。这项探索性研究记录了 10 名有神经性溃疡病史的患者（DNU；n=10）的灵活性和力量的临床测量值，以及下肢的三维生物力学步态数据。与年龄和性别相匹配的糖尿病周围神经病变且无溃疡史（DWN；n=10）、糖尿病且无周围神经病变（DNN；n=10）和非糖尿病对照组（NOND；n=10）进行了对比。生物力学数据是在舒适的步行速度下使用 Vicon 运动分析系统收集的。临床测量值显示，踝关节和第一跖趾关节的静态活动范围呈下降趋势，但无统计学意义，且神经病变程度恶化。在有溃疡病史的糖尿病组中，膝关节和踝关节的力量明显较低（p=0.01-0.03），但膝关节伸展除外。与 NOND 相比，DNU 组的平均步行速度慢 0.17ms（p=0.04）。与 NOND 相比，DNU 组在：髋关节（额状面，减少 25%：p=0.03）；髋关节和膝关节（横切面，减少 31%：p=0.01 和 32%：p<0.01）；踝关节（矢状面，减少 22%：p<0.01）和第一跖趾关节（矢状面，减少 32%：p=0.01）的活动范围较小，足部旋转减少（减少 24%：p=0.04）。DNU 中的动力学改变包括踝关节最大功率降低（21%：p=0.03）和垂直地面反作用力第二峰值降低（6%：p<0.01）。研究结果发现，有临床严重周围神经病变和相关足底足部溃疡病史的患者存在步态改变。需要进一步研究探索潜在的因果途径。
