title: Quantitative assessment of early biomechanical modifications in diabetic foot patients: the role of foot kinematics and step width.
abstract: BACKGROUND
  Forefoot ulcers (FU) are one of the most disabling and relevant chronic complications of diabetes mellitus (DM). In recent years there is emerging awareness that a better understanding of the biomechanical factors underlying the diabetic ulcer could lead to improve the management of the disease, with significant socio-economic impacts. Our purpose was to try to detect early biomechanical factors associated with disease progression.
  
  
  METHODS
  Thirty subjects (M/F: 22/8; mean age ± SD: 61,84 ± 10 years) with diagnosis of type II DM were included. The participants were divided into 3 groups (10 subjects per group) according to the stage of evolution of the disease: Group 1, subjects with newly diagnosed type II DM, without clinical or instrumental diabetic peripheral neuropathy (DPN) nor FU (group called "DM"); Group 2, with DPN but without FU (group called "DPN"); Group 3, with DPN and FU (group called "DNU"). All subjects underwent 3-D Gait Analysis during walking at self-selected speed, measuring spatio-temporal, kinematic and kinetic parameters and focusing on ankle and foot joints. The comparative analysis of values between groups was performed using 1-way ANOVA. We also investigated group to group differences with Tukey HSD test. The results taken into consideration were those with a significance of P < 0,05. 95 % confidence interval was also calculated.
  
  
  RESULTS
  A progressive and significant trend of reduction of ROM in flexion-extension of the metatarso-phalangeal joint (P = 0.0038) and increasing of step width (P = 0.0265) with the advance of the disease was evident, with a statistically significant difference comparing subjects with recently diagnosed diabetes mellitus and subjects with diabetic neuropathy and foot ulcer (P = 0.0048 for ROM and P = 0.0248 for step width at Tukey's test).
  
  
  CONCLUSIONS
  The results provide evidence that foot segmental kinematics, along with step width, can be proposed as simple and clear indicators of disease progression. This can be the starting point for planning more targeted strategies to prevent the occurrence and the recurrence of a FU in diabetic subjects.
authors.affiliation: Unit of Neurorehabilitation, Department of Neuroscience, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. giuseppe.lamola@yahoo.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lamola
authors.affiliation: Unit of Neurorehabilitation, Department of Neuroscience, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. cortomartina@gmail.com.
authors.forename: Martina
authors.initials: M
authors.lastname: Venturi
authors.affiliation: The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, viale Rinaldo Piaggio 34, 56025, Pisa, Italy. d.martelli@sssup.it.
authors.forename: Dario
authors.initials: D
authors.lastname: Martelli
authors.affiliation: Diabetic Foot Section, Department of Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. elisabettaiacopi@gmail.com.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Iacopi
authors.affiliation: Unit of Neurorehabilitation, Department of Neuroscience, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. c.fanciullacci@sssup.it.|The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, viale Rinaldo Piaggio 34, 56025, Pisa, Italy. c.fanciullacci@sssup.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fanciullacci
authors.affiliation: Diabetic Foot Section, Department of Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. albcopp@yahoo.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Coppelli
authors.affiliation: Unit of Neurorehabilitation, Department of Neuroscience, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. b.rossi@ao-pisa.toscana.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rossi
authors.affiliation: Diabetic Foot Section, Department of Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. piaggesi@immr.med.unipi.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Piaggesi
authors.affiliation: Unit of Neurorehabilitation, Department of Neuroscience, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy. c.chisari@ao-pisa.toscana.it.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Chisari
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000150:complications / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D016138:Walking