School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University , Manchester , United Kingdom.
School of Sport and Exercise Sciences, Liverpool John Moores University , Liverpool , United Kingdom.
J Appl Physiol (1985). 2018 May 1;124(5):1333-1340. doi: 10.1152/japplphysiol.00290.2017. Epub 2018 Feb 8.
The Achilles tendon (AT) has the capacity to store and release elastic energy during walking, contributing to metabolic energy savings. In diabetes patients, it is hypothesized that a stiffer Achilles tendon may reduce the capacity for energy saving through this mechanism, thereby contributing to an increased metabolic cost of walking (CoW). The aim of this study was to investigate the effects of diabetes and diabetic peripheral neuropathy (DPN) on the Achilles tendon and plantarflexor muscle-tendon unit behavior during walking. Twenty-three nondiabetic controls (Ctrl); 20 diabetic patients without peripheral neuropathy (DM), and 13 patients with moderate/severe DPN underwent gait analysis using a motion analysis system, force plates, and ultrasound measurements of the gastrocnemius muscle, using a muscle model to determine Achilles tendon and muscle-tendon length changes. During walking, the DM and particularly the DPN group displayed significantly less Achilles tendon elongation (Ctrl: 1.81; DM: 1.66; and DPN: 1.54 cm), higher tendon stiffness (Ctrl: 210; DM: 231; and DPN: 240 N/mm), and higher tendon hysteresis (Ctrl: 18; DM: 21; and DPN: 24%) compared with controls. The muscle fascicles of the gastrocnemius underwent very small length changes in all groups during walking (~0.43 cm), with the smallest length changes in the DPN group. Achilles tendon forces were significantly lower in the diabetes groups compared with controls (Ctrl: 2666; DM: 2609; and DPN: 2150 N). The results strongly point toward the reduced energy saving capacity of the Achilles tendon during walking in diabetes patients as an important factor contributing to the increased metabolic CoW in these patients. NEW & NOTEWORTHY From measurements taken during walking we observed that the Achilles tendon in people with diabetes and particularly people with diabetic peripheral neuropathy was stiffer, was less elongated, and was subject to lower forces compared with controls without diabetes. These altered properties of the Achilles tendon in people with diabetes reduce the tendon's energy saving capacity and contribute toward the higher metabolic energy cost of walking in these patients.
跟腱（AT）在行走过程中具有储存和释放弹性能量的能力，有助于节省代谢能量。在糖尿病患者中，人们假设更硬的跟腱可能会通过这种机制降低节能能力，从而增加行走的代谢成本（CoW）。本研究旨在探讨糖尿病和糖尿病周围神经病变（DPN）对跟腱和跖屈肌-肌腱单位在行走过程中的行为的影响。23 名非糖尿病对照者（Ctrl）；20 名无周围神经病变的糖尿病患者（DM）和 13 名中度/重度 DPN 患者接受步态分析，使用运动分析系统、力板和超声测量腓肠肌，使用肌肉模型确定跟腱和肌肉-肌腱长度变化。在行走过程中，DM 组，尤其是 DPN 组，跟腱伸长明显减少（Ctrl：1.81；DM：1.66；DPN：1.54cm），跟腱刚度显著增加（Ctrl：210；DM：231；DPN：240N/mm），跟腱滞后性显著增加（Ctrl：18；DM：21；DPN：24%）。与对照组相比，所有组在行走过程中腓肠肌肌束的长度变化都非常小（~0.43cm），DPN 组的长度变化最小。与对照组相比，糖尿病组的跟腱力明显降低（Ctrl：2666；DM：2609；DPN：2150N）。研究结果强烈表明，糖尿病患者在行走过程中跟腱的节能能力降低，是导致这些患者行走代谢 CoW 增加的重要因素。新的和值得注意的是：从行走过程中的测量中，我们观察到，与无糖尿病的对照组相比，糖尿病患者，尤其是糖尿病周围神经病变患者的跟腱更硬，伸长率更低，受力更小。糖尿病患者跟腱的这些特性改变降低了跟腱的储能能力，并导致这些患者行走的代谢能量消耗增加。
