title: Integrated kinematics-kinetics-plantar pressure data analysis: a useful tool for characterizing diabetic foot biomechanics.
abstract: 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.
authors.affiliation: Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy. zimi.sawacha@dei.unipd.it
authors.forename: Zimi
authors.initials: Z
authors.lastname: Sawacha
authors.forename: Gabriella
authors.initials: G
authors.lastname: Guarneri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cristoferi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guiotto
authors.forename: Angelo
authors.initials: A
authors.lastname: Avogaro
authors.forename: Claudio
authors.initials: C
authors.lastname: Cobelli
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000517:prevention & control; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D005528:Foot / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D011312:Pressure; D011859:Radiography; D012016:Reference Values; D013314:Stress, Mechanical