Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; School of Health Professions, Baylor College of Medicine, Houston, TX, USA.
Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.
Clin Biomech (Bristol). 2020 Mar;73:157-161. doi: 10.1016/j.clinbiomech.2020.01.014. Epub 2020 Jan 18.
Unilateral offloading footwear prescribed to patients with diabetic foot ulcers elevates one limb relative to the other, which may lead to limp and abnormal gait. This study investigated whether the unilateral foot ulcer and offloading combination negatively impacts gait function beyond diabetic peripheral neuropathy.
Eighty-six participants were recruited in 3 groups: 12 with diabetic peripheral neuropathy and unilateral foot ulcers wearing offloading footwear (offloading group, age = 55.6 ± 9.5 years, BMI = 30.9 ± 4.5 kg/m), 27 with diabetic peripheral neuropathy (neuropathy group, age = 64.3 ± 7.7 years, BMI = 30.9 ± 5.4 kg/m), and 47 non-diabetic controls (non-diabetic group, age = 62.9 ± 16.1 years, BMI = 29.0 ± 6.0 kg/m). Gait function was quantified during a habitual speed walking test using a validated wearable platform.
The offloading group exhibited deteriorated gait function compared to the non-diabetic group (p < 0.005, Cohen's effect size d = 0.90-2.61). They also had decreased gait speed (p < 0.001, d = 1.79) and stride length (p < 0.001, d = 1.76), as well as increased gait cycle time (p < 0.001, d = 1.67) and limp (p < 0.050, d = 0.72-1.49) compared to the neuropathy group. The offloading group showed increased gait unsteadiness compared to the neuropathy group, but the difference did not reach statistical significance in our samples.
This study demonstrated that while diabetic peripheral neuropathy deteriorates gait function, including increasing gait unsteadiness and limp, the diabetic foot ulcer and offloading combination magnifies the deterioration beyond diabetic peripheral neuropathy. These findings promote caution of the current standards of care for treating diabetic foot ulcers with offloading footwear. However, it is possible that a contralateral shoe lift may remedy deteriorated gait function and improve quality of life for unilateral offloading users.
为患有糖尿病足溃疡的患者开具的单侧减压鞋会使一条腿相对于另一条腿抬高，这可能导致跛行和异常步态。本研究调查了单侧足部溃疡和减压鞋的组合是否会对糖尿病周围神经病变以外的步态功能产生负面影响。
招募了 86 名参与者，分为 3 组：12 名患有糖尿病周围神经病和单侧足部溃疡的患者，穿着减压鞋（减压组，年龄 55.6 ± 9.5 岁，BMI 30.9 ± 4.5kg/m），27 名患有糖尿病周围神经病的患者（神经病组，年龄 64.3 ± 7.7 岁，BMI 30.9 ± 5.4kg/m）和 47 名非糖尿病对照者（非糖尿病组，年龄 62.9 ± 16.1 岁，BMI 29.0 ± 6.0kg/m）。使用经过验证的可穿戴平台在常规步行速度测试中定量步态功能。
与非糖尿病组相比，减压组的步态功能明显恶化（p<0.005，Cohen's 效应大小 d=0.90-2.61）。他们的步速（p<0.001，d=1.79）和步长（p<0.001，d=1.76）也降低了，步态周期时间（p<0.001，d=1.67）和跛行（p<0.050，d=0.72-1.49）也增加了。与神经病组相比，减压组的步态不稳定性也增加，但在我们的样本中，差异没有达到统计学意义。
本研究表明，虽然糖尿病周围神经病会恶化步态功能，包括增加步态不稳定性和跛行，但糖尿病足溃疡和减压鞋的组合会使步态恶化程度超出糖尿病周围神经病。这些发现促使我们对当前用减压鞋治疗糖尿病足溃疡的标准护理方案持谨慎态度。然而，使用对侧鞋提升可能会纠正步态功能的恶化，并提高单侧减压使用者的生活质量。
