title: The role of joint mobility in evaluating and monitoring the risk of diabetic foot ulcer.
abstract: OBJECTIVE
  Evaluation of how ankle joint mobility (AJM) can be useful in the identification of patients with diabetes at risk of foot ulcer (FU).
  
  
  METHODS
  Plantar and dorsal flexion of foot were evaluated using an inclinometer in 87 patients (54 type 2 and 33 type 1), and 35 healthy sex- and age-matched control subjects. Patients with diabetes were followed up for diagnosis of FU over the next 8 years and subsequently, patients were subdivided into: those without a history of FU (18 type 1 and 33 type 2), those who had a history of FU detected before baseline evaluation (14 type 2) and those who had history of first ulceration detected by the 8th year of the evaluation period (7 type 2).
  
  
  RESULTS
  Aging and diabetes caused a significant reduction in mobility of each of the movements investigated (p<0.001), whereas after adjusting for the confounding effect of age, diabetes specifically reduced plantar flexion (p<0.0001). AJM was significantly lower in those with history of previous FU compared to all the other groups (p<0.001). The first ulceration was detected in the same foot presenting lower AJM in 17 of the 22 subjects with diabetes with history of ulcer (77.27%).
  
  
  CONCLUSIONS
  Diabetes and aging reduce AJM although diabetes seems to reduce plantar flexion to a more specific extent. Reduced AJM is mostly associated with a previous history of FU. The evaluation of AJM is a valid and reliable ulcer risk scale that indicates which foot is at higher ulcer risk.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy. Electronic address: piergiorgiofrancia@libero.it.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Francia
authors.affiliation: Tuscany Regional Health Agency (ARS), Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Seghieri
authors.affiliation: Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gulisano
authors.affiliation: Diabetes Unit, USL 3, St. Jacopo Hospital, Pistoia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: De Bellis
authors.affiliation: Diabetes Unit, Meyer Children's Hospital, Florence, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Toni
authors.affiliation: Diabetes Unit, USL 3, St. Jacopo Hospital, Pistoia, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Tedeschi
authors.affiliation: Diabetes Unit, USL 3, St. Jacopo Hospital, Pistoia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Anichini
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology*; D017719:Diabetic Foot / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Ankle range of motion; Diabetic foot; Foot ulcer risk scale; Limited joint mobility