title: The effect of diabetic neuropathy and previous foot ulceration in EMG and ground reaction forces during gait.
abstract: BACKGROUND
  We aimed at investigating the influence of diabetic neuropathy and previous history of plantar ulcers on electromyography (EMG) of the thigh and calf and on vertical ground reaction forces during gait.
  
  
  METHODS
  This study involved 45 adults divided into three groups: a control group (n=16), diabetic neuropathic group (n=19) and diabetic neuropathic group with previous history of plantar ulceration (n=10). EMG of the right vastus lateralis, lateral gastrocnemius and tibialis anterior were studied during the stance phase. The peaks and time of peak occurrence were determined and a co-activation index between tibialis anterior and lateral gastrocnemius. In order to represent the effect of the changes in EMG, the first and second peaks and the minimum value of the vertical ground reaction force were also determined. Inter-group comparisons of the electromyographical and ground reaction forces variables were made using three MANCOVA (peaks and times of EMG and peaks of force) and one ANCOVA (co-activation index).
  
  
  RESULTS
  The ulcerated group presented a delayed in the time of the lateral gastrocnemius and vastus lateralis peak occurrence in comparison to control's. The lateral gastrocnemius delay may be related to the lower second vertical peak in diabetic subjects. However, the delay of the vastus lateralis did not cause any significant change on the first vertical peak.
  
  
  CONCLUSIONS
  The vastus lateralis and lateral gastrocnemius delay demonstrate that ulcerated diabetic neuropathic patients have a motor deficit that could compromise their ability to walk, which was partially confirmed by changes on ground reaction forces during the push-off phase.
authors.affiliation: Department of Physical Therapy, Speech and Occupational Therapy, Laboratory of Human Movement and Posture, School of Medicine, University of Sao Paulo, Brazil. p.akashi@usp.br
authors.forename: Paula M H
authors.initials: PM
authors.lastname: Akashi
authors.forename: Isabel C N
authors.initials: IC
authors.lastname: Sacco
authors.forename: Ricky
authors.initials: R
authors.lastname: Watari
authors.forename: Ewald
authors.initials: E
authors.lastname: Hennig
mesh_terms: D003929:Diabetic Neuropathies / Q000503:physiopathology*; D004576:Electromyography / Q000379:methods*; D005260:Female; D016523:Foot Ulcer / Q000503:physiopathology*; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000503:physiopathology*; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000503:physiopathology*