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.\ud \ud 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.\ud \ud 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).\ud \ud 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