Article

The fundamental cause of lower-extremity complications in diabetes is chronic
hyperglycemia leading to diabetic foot ulcer pathology. While the relationship
between abnormal plantar pressure distribution and plantar ulcers has been widely
investigated, little is known about the role of shear stress. Moreover, the
mutual relationship among plantar pressure, shear stress, and abnormal kinematics
in the etiology of diabetic foot has not been established. This lack of knowledge
is determined by the lack of commercially available instruments which allow such
a complex analysis. This study aims to develop a method for the simultaneous
assessment of kinematics, kinetics, and plantar pressure on foot subareas of
diabetic subjects by means of combining three commercial systems. Data were
collected during gait on 24 patients (12 controls and 12 diabetic neuropathics)
with a motion capture system synchronized with two force plates and two
baropodometric systems. A four segment three-dimensional foot kinematics model
was adopted for the subsegment angles estimation together with a three segment
model for the plantar sub-area definition during gait. The neuropathic group
exhibited significantly excessive plantar pressure, ground reaction forces on
each direction, and a reduced loading surface on the midfoot subsegment (p<0.04).
Furthermore the same subsegment displayed excessive dorsiflexion, external
rotation, and eversion (p<0.05). Initial results showed that this methodology may
enable a more appropriate characterization of patients at risk of foot ulcerations, and help planning prevention programs.
CI - Copyright (c) 2011 Elsevier B.V. All rights reserved.

Langue : ANGLAIS