Deschamps K, Matricali G A, Roosen P, Nobels F, Tits J, Desloovere K, Bruyninckx H, Flour M, Deleu P-A, Verhoeven W, Staes F
KU Leuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven, Laboratory for Clinical Motion Analysis, University Hospital Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium; KU Leuven, Multidisciplinary Diabetic Foot Clinic, University Hospitals Leuven, Weligerveld 1, 3212 Pellenberg, Belgium; Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Bruxelles, Weligerveld 1, 3212 Pellenberg, Belgium.
Clin Biomech (Bristol). 2013 Aug;28(7):813-9. doi: 10.1016/j.clinbiomech.2013.06.008. Epub 2013 Jul 3.
Reduction in foot mobility has been identified as a key factor of altered foot biomechanics in individuals with diabetes mellitus. This study aimed at comparing in vivo segmental foot kinematics and coupling in patients with diabetes with and without neuropathy to control adults.
Foot mobility of 13 diabetic patients with neuropathy, 13 diabetic patients without neuropathy and 13 non-diabetic persons was measured using an integrated measurement set-up including a plantar pressure platform and 3D motion analysis system. In this age-, sex- and walking speed matched comparative study; differences in range of motion quantified with the Rizzoli multisegment foot model throughout different phases of the gait cycle were analysed using one-way repeated measures analysis of variance (ANOVA). Coupling was assessed with cross-correlation techniques.
Both cohorts with diabetes showed significantly lower motion values as compared to the control group. Transverse and sagittal plane motion was predominantly affected with often lower range of motion values found in the group with neuropathy compared to the diabetes group without neuropathy. Most significant changes were observed during propulsion (both diabetic groups) and swing phase (predominantly diabetic neuropathic group). A trend of lower cross-correlations between segments was observed in the cohorts with diabetes.
Our findings suggest an alteration in segmental kinematics and coupling during walking in diabetic patients with and without neuropathy. Future studies should integrate other biomechanical measurements as it is believed to provide additional insight into neural and mechanical deficits associated to the foot in diabetes.
足部活动度降低已被确定为糖尿病患者足部生物力学改变的关键因素。本研究旨在比较有神经病变和无神经病变的糖尿病患者与健康对照成年人的体内节段性足部运动学及耦合情况。
使用包括足底压力平台和三维运动分析系统的综合测量装置，测量13例有神经病变的糖尿病患者、13例无神经病变的糖尿病患者和13例非糖尿病患者的足部活动度。在这项年龄、性别和步行速度匹配的比较研究中，使用单向重复测量方差分析（ANOVA）分析在整个步态周期不同阶段用里佐利多节段足部模型量化的运动范围差异。用互相关技术评估耦合情况。
与对照组相比，两个糖尿病队列的运动值均显著降低。与无神经病变的糖尿病组相比，有神经病变的组中横向和矢状面运动主要受到影响，其运动范围值通常更低。在推进期（两个糖尿病组）和摆动期（主要是糖尿病神经病变组）观察到最显著的变化。在糖尿病队列中观察到节段间互相关较低的趋势。
我们的研究结果表明，有和无神经病变的糖尿病患者在行走过程中节段运动学和耦合存在改变。未来的研究应纳入其他生物力学测量，因为据信这将为糖尿病患者足部相关的神经和机械缺陷提供更多见解。
