title: Gait parameters of people with diabetes-related neuropathic plantar foot ulcers.
abstract: Foot ulceration associated with diabetic peripheral neuropathy is a global concern. Biomechanical investigation allows the identification of gait abnormalities that may adversely affect ulcer healing. The objective of this case-control study was to compare the gait parameters of cases with diabetes-related foot ulcers to controls.
  
  
  
  Three-dimensional movement analyses were performed on 21 people with diabetes-related neuropathic plantar foot ulcers (cases), 69 people with diabetes without a foot ulcer history (diabetes controls) and 56 healthy controls. Outcome data were reported as mean differences, 95% confidence intervals and Cohen's d effect sizes. Binary logistic regressions were used to adjust for age, sex and body mass index.
  
  
  
  People with foot ulcers had a smaller plantar flexion (Cohen's d=-0.6 vs. diabetes controls and d=-0.8 vs. healthy controls), knee flexion (d=-0.6 vs. diabetes controls and d=-1.0 vs. healthy controls) and pelvic obliquity (d=-0.9 vs. diabetes controls and d=-0.7 vs. healthy controls) (all P<0.05). They also had a significantly greater range of anterior-posterior ground reaction force (d=1.0 vs. diabetes controls and d=1.7 vs. healthy controls) and total vertical ground reaction force (d=0.9 vs. diabetes controls and d=1.1 vs. healthy controls) and significantly slower walking speed and smaller step length compared to controls (all P<0.05).
  
  
  
  People with plantar foot ulcers have considerably different gait parameters to controls. Whether the observed gait parameters contributed to the ulcer development or are a response to the ulcer is currently unclear and needs further investigation.
authors.affiliation: Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Movement Analysis Laboratory, Sport and Exercise, James Cook University, Townsville, Queensland, Australia; Podiatry Service, Kirwan Community Health Campus, Townsville Hospital & Health Service, Townsville, Queensland, Australia. Electronic address: malindu.fernando@my.jcu.edu.au.
authors.forename: Malindu Eranga
authors.initials: ME
authors.lastname: Fernando
authors.affiliation: Movement Analysis Laboratory, Sport and Exercise, James Cook University, Townsville, Queensland, Australia; Sport and Exercise, School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Crowther
authors.affiliation: Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lazzarini
authors.affiliation: Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: Kunwarjit S
authors.initials: KS
authors.lastname: Sangla
authors.affiliation: Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia.
authors.forename: Petra
authors.initials: P
authors.lastname: Buttner
authors.affiliation: Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, The Townsville Hospital, Queensland, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Golledge
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D017719:Diabetic Foot / Q000503:physiopathology*; D005260:Female; D005528:Foot / Q000503:physiopathology*; D016523:Foot Ulcer / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Biomechanics; Diabetic foot disease; Foot ulceration; Gait; Peripheral diabetic neuropathy; Plantar ulcers