Ankle joint mobility and plantar pressure distribution of patients with diabetic neuropathy

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Ankle joint mobility and plantar pressure distribution of patients with diabetic neuropathy

 

Author: Shum, Wai-hung Anthony
Title: Ankle joint mobility and plantar pressure distribution of patients with diabetic neuropathy
Degree: M.Sc.
Year: 2009
Subject: Hong Kong Polytechnic University -- Dissertations.
Diabetic neuropathies.
Diabetes -- Complications.
Ankle -- Wounds and injuries.
Foot -- Diseases.
Department: Dept. of Health Technology and Informatics
Pages: x, 81 leaves : ill. (some col.) ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2303572
URI: http://theses.lib.polyu.edu.hk/handle/200/3711
Abstract: Background Diabetic is a significant public health problem. In Hong Kong, the prevalence of diabetic mellitus is increasing every year and the majority of lower limb amputation is due to Diabetes Mellitus. This irreversible loss of limb not only shortens the life span of an individual but also impairs the quality of life. Diabetic foot disease is comprised of foot ulceration and lower limbs amputation and they are the largest portions of individuals with non-traumatic amputation. Limited joints mobility and elevated plantar pressure have been associated with diabetic foot ulceration, but the presence of peripheral neuropathy give the greatest risk on developing diabetic ulceration. Thus, there is an urge need in identifying those high-risk patient so that resource can be channeled to these patients in the prevention of ulcer occurrence and hence amputation. Purpose The purposes of this study were to investigate the ankle joint mobility and plantar pressure distribution of patients with diabetic neuropathy. Plantar pressure analysis was performed to compare the peak pressure and pressure time integral and measure limited joint mobility on dorsiflexion of ankle joint with the presence of diabetic peripheral neuropathy. Subjects A total of 20 diabetic subjects participated in this study: 10 with diabetes mellitus and without peripheral neuropathy (DM group) and 10 with diabetes mellitus and with peripheral neuropathy (DPN group). The DM group (1 men, 9 women) had a mean age (+-SD) of 55+-6.2 years. The DPN group (6 men, 4 women) had a mean age (+-SD) of 57.9+-7.9 years. All subjects had type II diabetes mellitus and no significant differences were found between age (p=0.373), height (p=0.055), weight (p=0.23), body mass index (p=0.82), diabetes duration (p=0.45) and HbA1c level (p=0.102). Method Presence of diabetic peripheral neuropathy was confirmed by 5.07 Semmes-Weinstein monofilaments on 10 sites of foot. Active ankle dorsiflexion range of motion was measured by goniometer. Plantar peak pressure (PP) and pressure time integrals (PTI) on four forefoot regions were measured during barefoot walking by using Tekscan Walkway with two-step method. Result The DPN group had significantly reduced ankle dorsiflexion range of motion by 65.3% than those subjects on DM group. (3.4+-4.3 degree versus 9.8+-5 degree, p=0.004). Peak pressure on medial forefoot was significantly increased (p=0.018) in DPN group (421.4+-251.6 kPa) than DM group (209.1+-52.8 kPa) with 50.4% difference. However there were no significant differences on hallux region (p=0.271), central forefoot (p=0.93) and lateral forefoot (p=0.292). Pressure time integrals on medial forefoot were significantly increased (p=0.019) in DPN group (57.7+-26.8 kPa.S) than DM group (34.8+-8.9 kPa.S) with 39.7% difference. However there were no significant differences on hallux (p=0.63), central forefoot (p=0.681) and lateral forefoot (p=0.525). Conclusion This study reveals the effect of diabetic neuropathy on ankle joint mobility and plantar pressure distribution on various regions of forefoot in patients with Diabetes Mellitus. These finding were clinical significance because we can identify risk of ulceration on patients with diabetic neuropathy and preventive measure can apply on those patients by various off-loading technique such as rocker bottom shoe. The pressure variables obtained in this study were valuable to Orthopedic surgeon by provide the baseline data for future prophylactic surgical intervention on percutaneous Achilles tendon lengthening. Although not all diabetic foot ulcers can be prevented, it is possible to effect reduction in the incidence and morbidity through appropriate foot screening and management.

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