The online version of this article (doi:10.1186/s12902-015-0057-7) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
MEF conceived the study, and drafted the first version of the manuscript. RC assisted with developing the methods for the study, trained MEF on how to perform all assessments, assisted with biomechanical outcome definitions and edited the manuscript for publication. MC assisted with the development of the methods and analyses and edited the manuscript for publication. PL provided intellectual input on the design and methods of the study, especially in relation to foot ulcer outcomes and edited the manuscript for publication. KS provided clinical expertise on diabetes participants and research methods and edited the manuscript for publication. JG assisted with planning study methodology and contributed to writing and editing of the manuscript for publication. All authors read and approved the final manuscript.
Foot ulceration is the main precursor to lower limb amputation in patients with type 2 diabetes worldwide. Biomechanical factors have been implicated in the development of foot ulceration; however the association of these factors to ulcer healing remains less clear. It may be hypothesised that abnormalities in temporal spatial parameters (stride to stride measurements), kinematics (joint movements), kinetics (forces on the lower limb) and plantar pressures (pressure placed on the foot during walking) contribute to foot ulcer healing. The primary aim of this study is to establish the biomechanical characteristics (temporal spatial parameters, kinematics, kinetics and plantar pressures) of patients with plantar neuropathic foot ulcers compared to controls without a history of foot ulcers. The secondary aim is to assess the same biomechanical characteristics in patients with foot ulcers and controls over-time to assess whether these characteristics remain the same or change throughout ulcer healing.
The design is a case–control study nested in a six-month longitudinal study. Cases will be participants with active plantar neuropathic foot ulcers (DFU group). Controls will consist of patients with type 2 diabetes (DMC group) and healthy participants (HC group) with no history of foot ulceration. Standardised gait and plantar pressure protocols will be used to collect biomechanical data at baseline, three and six months. Descriptive variables and primary and secondary outcome variables will be compared between the three groups at baseline and follow-up.
It is anticipated that the findings from this longitudinal study will provide important information regarding the biomechanical characteristic of type 2 diabetes patients with neuropathic foot ulcers. We hypothesise that people with foot ulcers will demonstrate a significantly compromised gait pattern (reduced temporal spatial parameters, kinematics and kinetics) at base line and then throughout the follow-up period compared to controls. The study may provide evidence for the design of gait-retraining, neuro-muscular conditioning and other approaches to off-load the limbs of those with foot ulcers in order to reduce the mechanical loading on the foot during gait and promote ulcer healing.
Additional file 1: Supplementary data file S1. PDF document containing the case report form for data collection. (PDF 1054 kb)12902_2015_57_MOESM1_ESM.pdf
Cavanagh PR, Ulbrecht JS. Clinical plantar pressure measurement in diabetes: rationale and methodology. Foot. 1994;4(3):123–35. CrossRef
Fernando ME, Crowther RG, Pappas E, Lazzarini PA, Cunningham M, Sangla KS, et al. Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies. PLoS ONE. 2014;9(6):e99050. PubMedCentralCrossRefPubMed
Fernando M, Crowther R, Lazzarini P, Sangla K, Cunningham M, Buttner P, et al. Biomechanical characteristics of peripheral diabetic neuropathy: a systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure. Clin Biomech (Bristol, Avon). 2013;28(8):831–45. CrossRef
Sartor CD, Watari R, Passaro AC, Picon AP, Hasue RH, Sacco IC. Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial. BMC Musculoskelet Disord. 2012;13(1):36. PubMedCentralCrossRefPubMed
Diabetes Australia. NDSS National Diabetes Services Scheme Map. 2013. http://www.diabetesmap.com.au/#/. Accessed 14 th Feb 2015.
Mancera-Romero J, Rodriguez-Morata A, Angel Sanchez-Chaparro M, Sanchez-Perez M, Paniagua-Gomez F, Hidalgo-Conde A, et al. Role of an intermittent claudication questionnaire for the diagnosis of PAD in ambulatory patients with type 2 diabetes. Int Angiol. 2013;32(5):512–7. PubMed
Fowler MJ. Microvascular and macrovascular complications of diabetes. Clinical Diabetes. 2008;26(2):77–82. CrossRef
Mooradian AD. Dyslipidemia in type 2 diabetes mellitus. Nat Clin Pract End Met. 2009;5(3):150–9. CrossRef
Harris EH. Elevated liver function tests in type 2 diabetes. Clin Diabetes. 2005;23(3):115–9. CrossRef
Johnson DW, Jones GR, Mathew TH, Ludlow MJ, Doogue MP, Jose MD, et al. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: new developments and revised recommendations. MJA. 2012;197(4):224–5.
Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist circumference and cardiometabolic risk: a consensus statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Am J Clin Nutr. 2007;85(5):1197–202. PubMed
Luyan W. GW25-e4192 Comparison of digital blood pressure device and mercury sphygmomanometers. J Am Coll Cardiol. 2014;64(16). doi: 10.1016/j.jacc.2014.06.831.
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the subcommittee of professional and public education of the American Heart Association Council on high blood pressure research. Hypertension. 2005;45(1):142–61. CrossRefPubMed
Wofford MR, Harkins KG, King DS, Habeeb GE, Wyatt SB, Jones DW. P-175: accurate cuff size in blood pressure measurement. Am J Hypertens. 2002;15(S3):92A. CrossRef
Kruse I, Edelman S. Evaluation and treatment of diabetic foot ulcers. Clin Diabetes. 2006;24(2):91–3. CrossRef
Stubbing NJ, Bailey P, Poole M. Protocol for accurate assessment of ABPI in patients with leg ulcers. J Wound Care. 1997;6(9):417–8. PubMed
Hu H, Li H, Zheng FP, Cheng Y, Miao J, Zhang W. A comparison of clinical effectiveness of different neuropathy scoring systems in screening asymptomatic diabetic peripheral neuropathy. Zhonghua Nei Ke Za Zhi. 2012;51(1):13–7. PubMed
England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, et al. Distal symmetrical polyneuropathy: a definition for clinical research. A report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Arch Phys Med Rehabil. 2005;86(1):167–74. CrossRefPubMed
Elveru RA, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: Subtalar and ankle joint measurements. Phys Ther. 1988;68(5):672–7. PubMed
Menz HB, Fotoohabadi MR, Wee E, Spink MJ. Visual categorisation of the Arch Index: a simplified measure of foot posture in older people. J Foot Ankle Res. 2012;5 Suppl 1:15. CrossRef
Piaggesi A, Palumbo F, Tedeschi A, Ambrosini L, Macchiarini S, Scatena A, et al. Measurements in the diabetic foot. Wounds. 2005;17(9):247–54.
Apelqvist J. The foot in perspective. Diabetes Metab Res Rev. 2008;24 Suppl 1:110–5. CrossRef
Nelson EA, O’Meara S, Craig D, Iglesias C, Golder S, Dalton J, et al. A series of systematic reviews to inform a decision analysis for sampling and treating infected diabetic foot ulcers. Health Technol Assess. 2006;10(12):3. –4, 9–10, 1–221. CrossRef
Armstrong DG, Lavery LA. Evidence-based options for off-loading diabetic wounds. Clin Podiatr Med Surg. 1998;15(1):95–104. PubMed
Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician. 2002;66(9):1655–62. PubMed
Davis RB, Ounpuu S, Tyburski D, Gage JR. A gait analysis data collection and reduction technique. Hum Mov Sci. 1991;10:575–87. CrossRef
Whittle J. Whittle’s Gait Analysis. 5th ed. China: Elsevier; 2012.
Vicon. Plugin Nexus Plugin Gait Product Guide. In: Foundation_Rev2.0_2010April. Metrics, Online. 2010. http://vicon.com/downloads. Accessed 15th December 2014.
Wolfson L. Gait and balance dysfunction: a model of the interaction of age and disease. Neuroscientist. 2001;7(2):178–83.
Ludbrook J. Multiple comparison procedures updated. Clin Exp Pharmacol Physiol. 1998;25(12):1032–7.
Knudson D. Significant and meaningful effects in sports biomechanics research. Sports Biomech. 2009;8(1):96–104.
- Lower limb biomechanical characteristics of patients with neuropathic diabetic foot ulcers: the diabetes foot ulcer study protocol
Malindu Eranga Fernando
Robert George Crowther
Peter Anthony Lazzarini
Kunwarjit Singh Sangla
- BioMed Central
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