Gait parameters of people with diabetes-related neuropathic plantar foot ulcers

Background: 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.

Methods: 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.

Findings: 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).

Interpretation: 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.