title: Foot biomechanics in patients with diabetes mellitus: doubts regarding the relationship between neuropathy, foot motion, and deformities.
abstract: BACKGROUND
  We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities.
  
  
  METHODS
  This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed.
  
  
  RESULTS
  No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039).
  
  
  CONCLUSIONS
  Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors.
authors.affiliation: Diabetic Foot Unit, University Podiatric Clinic, College of Podiatry, Universidad Complutense de Madrid, Madrid, Spain. diabetes@enf.ucm.es
authors.forename: José Luis
authors.initials: JL
authors.lastname: Lázaro-Martínez
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Aragón-Sánchez
authors.forename: Juan Vicente
authors.initials: JV
authors.lastname: Beneit-Montesinos
authors.forename: Maximo A
authors.initials: MA
authors.lastname: González-Jurado
authors.forename: Esther
authors.initials: E
authors.lastname: García Morales
authors.forename: David
authors.initials: D
authors.lastname: Martínez Hernández
mesh_terms: D001696:Biomechanical Phenomena; D002145:Callosities / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003929:Diabetic Neuropathies / Q000453:epidemiology*; D005260:Female; D005530:Foot Deformities / Q000453:epidemiology; D033023:Foot Joints / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D016059:Range of Motion, Articular / Q000502:physiology*