The effect of joint mobility on plantar pressures and walking capacity in diabetic patients with and without previous foot ulceration.

The prevalence of diabetes mellitus is dramatically high and is further
increasing due to the aging of the population and changes in lifestyle.
Diabetic neuropathy is the most frequent complication of diabetes. It presents
a group of clinical syndromes, among which the most frequent is distal, mainly
sensory polyneuropathy. Diabetic peripheral neuropathy causes changes in foot
structure, affecting foot function and subsequently leading to increased
plantar foot pressure, which is a predictive risk factor for the development of
diabetic foot ulceration. Loss of protective sensation, development of foot
deformities, limited joint mobility and reduced plantar soft tissue thickness
all contribute to an increased risk of foot ulceration. It is estimated that
the lifetime risk of a foot ulcer for any diabetic patient is approximately
15%. Foot ulceration is a major cause of disability and is one of the most
common causes for hospital admission among diabetic patients.

Limited joint mobility (LJM) is a common manifestation of diabetes. The
condition is usually most prominent in the hands but also affects the joints of
the ankle and foot in diabetic patients and may predispose to increased plantar
pressure and foot ulceration, and may lead to difficulties with walking.
Although LJM of the foot has been shown to be related to increased plantar
pressure and to foot ulceration, the role of joint mobility in the development
of foot ulceration is still not completely understood. Additionally, mobility
of more proximal joints such as the knee and hips or the role of LJM on walking
capacity has not been investigated before. It is hypothesized that reduced
joint mobility also exists at more proximal joints, and that this also could
contribute to increased plantar foot pressures. Furthermore, walking capacity
in patients with peripheral neuropathy may be compromised due to reduced
stability and LJM; however this has not been addressed in the literature
before. Reduced walking ability may lead to a reduced walking activity and this
is an undesirable consequence as the benefits of regular walking are well
established and walking has been entitled as the best medicine for diabetes.
More knowledge about the effect of limited joint mobility on foot pressure and
walking capacity are necessary in order to be able to design future clinical
interventions and intervention studies aiming to improve physical activity in
daily life in diabetic neuropathic patients.

The objective of this project is to assess joint mobility of the foot, knee and
hip to investigate in more detail the relationship between joint mobility of
the lower extremity, plantar pressures and walking capacity in diabetic
patients with and without a history of foot ulceration.

A cross-sectional observational study.

Patients will attend the department of rehabilitation of the AMC once. During
this visit a short clinical examination will take place, a 2 minute walking
test and gait analyis will be performed, and foot pressures will be assessed.
The workload of the different tests is possible if enough resting breaks are
taken between the different tests.