Lower limb biomechanical characteristics of patients with neuropathic diabetic foot ulcers: the diabetes foot ulcer study protocol.
BACKGROUND
Foot ulceration is the main precursor to lower limb amputation in patients with type 2 diabetes worldwide. Biomechanical factors have been implicated in the development of foot ulceration; however the association of these factors to ulcer healing remains less clear. It may be hypothesised that abnormalities in temporal spatial parameters (stride to stride measurements), kinematics (joint movements), kinetics (forces on the lower limb) and plantar pressures (pressure placed on the foot during walking) contribute to foot ulcer healing. The primary aim of this study is to establish the biomechanical characteristics (temporal spatial parameters, kinematics, kinetics and plantar pressures) of patients with plantar neuropathic foot ulcers compared to controls without a history of foot ulcers. The secondary aim is to assess the same biomechanical characteristics in patients with foot ulcers and controls over-time to assess whether these characteristics remain the same or change throughout ulcer healing.


METHODS
The design is a case-control study nested in a six-month longitudinal study. Cases will be participants with active plantar neuropathic foot ulcers (DFU group). Controls will consist of patients with type 2 diabetes (DMC group) and healthy participants (HC group) with no history of foot ulceration. Standardised gait and plantar pressure protocols will be used to collect biomechanical data at baseline, three and six months. Descriptive variables and primary and secondary outcome variables will be compared between the three groups at baseline and follow-up.


CONCLUSIONS
It is anticipated that the findings from this longitudinal study will provide important information regarding the biomechanical characteristic of type 2 diabetes patients with neuropathic foot ulcers. We hypothesise that people with foot ulcers will demonstrate a significantly compromised gait pattern (reduced temporal spatial parameters, kinematics and kinetics) at base line and then throughout the follow-up period compared to controls. The study may provide evidence for the design of gait-retraining, neuro-muscular conditioning and other approaches to off-load the limbs of those with foot ulcers in order to reduce the mechanical loading on the foot during gait and promote ulcer healing.
Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. malindu.fernando@my.jcu.edu.au.|Movement analysis Laboratory, Discipline of Sports and Exercise Science, James Cook University, Townsville, Australia. malindu.fernando@my.jcu.edu.au.|Podiatry Service, Kirwan Community Health Campus, Townsville, QLD, Australia. malindu.fernando@my.jcu.edu.au.
Malindu Eranga
ME
Fernando
Movement analysis Laboratory, Discipline of Sports and Exercise Science, James Cook University, Townsville, Australia. robert.crowther@usq.edu.au.|Sport and Exercise, School of Health and Wellbeing, University of Southern Queensland, Brisbane, Australia. robert.crowther@usq.edu.au.
Robert George
RG
Crowther
Department of Health Sciences, University of Stirling, Stirling, Scotland, UK. margaret.cunningham@stir.ac.uk.
Margaret
M
Cunningham
Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia. peter.lazzarini@health.qld.gov.au.|School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia. peter.lazzarini@health.qld.gov.au.
Peter Anthony
PA
Lazzarini
Department of Internal Medicine, The Townsville Hospital, Townsville, Australia. kunwarjit.sangla@health.qld.gov.au.
Kunwarjit Singh
KS
Sangla
Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. jonathan.golledge@jcu.edu.au.|Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia. jonathan.golledge@jcu.edu.au.
Jonathan
J
Golledge
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D017719:Diabetic Foot / Q000209:etiology / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000209:etiology / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult
D015415:Biomarkers