Diabetic gait and posture abnormalities: A biomechanical investigation through three dimensional gait analysis

医学 后备箱 步态 物理医学与康复 多发性神经病 糖尿病 鞋跟 步态分析 糖尿病神经病变 内科学 解剖 生态学 生物 内分泌学
作者
Z. Sawacha,G. Guarneri,G. Cristoferi,A. Guiotto,Angelo Avogaro,Claudio Cobelli
出处
期刊:Clinical Biomechanics [Elsevier BV]
卷期号:24 (9): 722-728 被引量:146
标识
DOI:10.1016/j.clinbiomech.2009.07.007
摘要

Diabetic sensorimotor polyneuropathy is a long-term diabetic complication. It is involved in the pathogenesis of the diabetic foot, which is a major cause of morbidity and mortality. The study aims to investigate the effects of diabetic polyneuropathy on gait and posture.Sixty seven subjects were enrolled: 21 diabetics without polyneuropathy, 26 with polyneuropathy, 20 controls (respectively, mean age 63.8 (SD 5.4), 63.2 (SD 5.6), 59.0 (SD 5.2) years, mean body mass index 26.3 (SD 2.5), 25.6 (SD 3), 24.0 (SD 2.9)). Postural and morphological evaluation and gait analysis were performed. Physical examination, together with a motion capture system synchronized with two force plates and two baropodometric systems were used. We evaluated lower limb mobility, foot deformities, trunk and pelvic posture, knee and heel position, plantar foot arch, three dimensional kinematics and kinetics during gait. The effect of peripheral vascular disease and microangiopathy on trunk and lower limb motion was also evaluated.Trunk and lower limb joint mobility (in static and dynamic states) were more reduced in diabetics either with or without polyneuropathy on each plane; however in diabetics with polyneuropathy significantly lower ranges of motion were registered. Furthermore, both groups showed significant reductions in each joint moment and velocity (P0.003) during gait. In presence of both vasculopathy and microangiopathy a further significant reduction (P0.001) was noticed.Altered gait and posture were found in diabetic patients irrespective of polyneuropathy. This approach may be relevant to predict the risk ulceration before clinically detectable neuropathy.
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