Assessment of the effects of diabetes on midfoot joint pressures using a robotic gait simulator.
BACKGROUND
One of the more serious diabetic complications is Charcot neuroarthropathy (CN), a disease that results in arch collapse and permanent foot deformity. However, very little is known about the etiology of CN. From a mechanical standpoint, it is likely that there is a ;;vicious circle'' in terms of (i) arch collapse causing increased midfoot joint pressures, and (ii) increased joint contact pressures exacerbating the collapse of midfoot bones. This study focused on assessment of peak joint pressure difference between diabetic and non-diabetic cadaver feet during simulated walking. We hypothesized that joint pressures are higher for diabetics than normal population.


METHODS
Sixteen cadaver foot specimens (eight control and eight diabetic specimens) were used in this study. Human gait at 25% of typical walking speed (averaged stance duration of 3.2s) was simulated by a custom-designed Universal Musculoskeletal Simulator. Four medial midfoot joint pressures (the first metatarsocuneiform, the medial naviculocuneiform, the middle naviculocuneiform, and the first intercuneiform) were measured dynamically during full stance.


RESULTS
The pressures in each of the four measured midfoot joints were significantly greater in the diabetic feet (p = 0.015, p = 0.025, p < 0.001, and p = 0.545, respectively).


CONCLUSIONS
Across all four tested joints, the diabetic cadaver specimens had, on average, 46% higher peak pressures than the control cadaver feet during the simulated stance phase.


CONCLUSIONS
This finding suggests that diabetic patients could be predisposed to arch collapse even before there are visible signs of bone or joint abnormalities.
Lee
Dong Gil
DG
Lerner Research Institute, Department of Biomedical Engineering, Cleveland, OH 44195, USA.
Davis
Brian L
BL
D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000503:physiopathology; D001177:Arthropathy, Neurogenic / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D002102:Cadaver; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D016059:Range of Motion, Articular; D012371:Robotics; D013640:Tarsal Joints / Q000503:physiopathology*; D016138:Walking / Q000502:physiology*; D016474:Weight-Bearing / Q000502:physiology*