Gait parameters of people with neuropathic diabetic foot ulcers
Busy times for Australian researchers, with another paper being published this week. This latest research is on the fundamental side of the research spectrum, focusing on gait parameters of people with neuropathic diabetic foot ulcers. It is an article to avoid if you are looking for direct clinical implications; however, it is a must read for researchers and clinicians working with biomechanics, as this is the first study that actually investigates gait in people with a foot ulcer in comparison to various controls.
The researchers invited 21 people with neuropathic diabetic foot ulcers, 69 people with diabetes but without a foot ulcer history (and unclear neuropathy status), and 56 healthy controls without diabetes, to their gait lab. Marked differences were found between people with a foot ulcer and both control groups, in kinematic, kinetic and spatio-temporal parameters.
A detailed discussion of these differences is beyond the scope of this short summary, it is better to read the full article. What is most important is that some differences are similar to what others have found in people with neuropathy but without a foot ulcer, and some are different. As the authors describe in their discussion, these differences may be the result of a response to the ulcer itself, or representative of why they developed an ulcer.
The fact that there’s a twofold explanation possible is perhaps the most important limitation of the current paper. The research would have greatly benefited from inclusion of a control group with neuropathy and a history of foot ulceration, but without a current ulcer. If these people would have been included as well, uncertainties to differences being reflective of a response to the ulcer or causing the ulcer could have been answered.
A strong point of the study is the strict published protocol followed, with all people measured during barefoot walking. This gives rigor to the current findings, something that has been missing from previous studies. A useful future study would be to compare gait parameters in people with an ulcer both while walking barefoot, as well as while wearing their offloading device.
Concluding, this piece adds a nice brick to our wall of knowledge on gait patterns in people with diabetic neuropathy, and is a great follow up from two systematic reviews published by the same group (one on biomechanical characteristics of neuropathy and the other on plantar pressure in people with and without a foot ulcer). For clinicians, the multiple differences found here emphasize once more the importance of biomechanical understanding of gait in people with diabetic foot ulcers.