title: Assessment of lower leg muscle force distribution during isometric ankle dorsi and plantar flexion in patients with diabetes: a preliminary study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the differences in ankle muscle strength using hand-held dynamometry and to assess difference in the isometric muscle force distribution between the people with diabetes and control participants.
  
  
  METHODS
  The maximal muscle strength of ankle plantarflexion, dorsiflexion, eversion, inversion, lesser toes flexors and extensors, hallux flexors, and extensors was assessed in 20 people with diabetes and 20 healthy participants using hand-held dynamometry. The maximal isometric ankle plantarflexion and dorsiflexion were imported to OpenSim software to calculate 12 individual muscle (8 plantarflexors and 4 dorsiflexors) forces acting on ankle joint.
  
  
  RESULTS
  A significant reduction in ankle strength for all measured actions and a significant decrease in muscle force for each of the 12 muscles during dorsi and plantar flexion were observed. Furthermore, the ratios of agonist to antagonist muscle force for 6 of the muscles were significantly different between the control group and the group with diabetes.
  
  
  CONCLUSIONS
  It is likely that the muscles for which the agonist/antagonist muscle force ratio was significantly different for the healthy people and the people with diabetes could be more affected by diabetes.
authors.affiliation: Department of Physiotherapy, Józef Piłsudski University of Physical Education, Warsaw, Poland; CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK. Electronic address: michalinablazkiewicz@gmail.com.
authors.forename: Michalina
authors.initials: M
authors.lastname: Błażkiewicz
authors.affiliation: CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK; AR Hospitals, India Diabetic Research Foundation, Egmore, Chennai, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Sundar
authors.affiliation: CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK.
authors.forename: Aoife
authors.initials: A
authors.lastname: Healy
authors.affiliation: AR Hospitals, India Diabetic Research Foundation, Egmore, Chennai, India.
authors.forename: Ambady
authors.initials: A
authors.lastname: Ramachandran
authors.affiliation: CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK.
authors.forename: Nachiappan
authors.initials: N
authors.lastname: Chockalingam
authors.affiliation: CSHER, Faculty of Health Sciences, Staffordshire University, Stoke on Trent, ST4 2DF, UK.
authors.forename: Roozbeh
authors.initials: R
authors.lastname: Naemi
mesh_terms: D000368:Aged; D000465:Algorithms; D000843:Ankle Joint; D001696:Biomechanical Phenomena; D003198:Computer Simulation; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D005528:Foot; D006801:Humans; D007537:Isometric Contraction; D007866:Leg; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D053580:Muscle Strength; D053581:Muscle Strength Dynamometer; D018908:Muscle Weakness / Q000175:diagnosis* / Q000209:etiology; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010865:Pilot Projects; D012720:Severity of Illness Index; D012984:Software
keywords: Agonist; Antagonist; Biomechanics; Diabetic Neuropathy; Musculoskeletal model