Lower limb gait joint coordination variability in people with diabetes-related foot ulcers

Robert G Crowther; Aaron Robertson; Malindu E Fernando; Peter A Lazzarini; Kunwarjit S Sangla; Jonathan Golledge

doi:10.1016/j.clinbiomech.2024.106382

Lower limb gait joint coordination variability in people with diabetes-related foot ulcers

Clin Biomech (Bristol). 2024 Nov 18:121:106382. doi: 10.1016/j.clinbiomech.2024.106382. Online ahead of print.

Authors

Robert G Crowther¹, Aaron Robertson², Malindu E Fernando³, Peter A Lazzarini⁴, Kunwarjit S Sangla⁵, Jonathan Golledge⁶

Affiliations

¹ Exercise and Sports Science, School of Science and Technology, Armidale, New South Wales, Australia. Electronic address: rcrowth2@une.edu.au.
² School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
³ Gait Analysis Laboratory, Institute of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia; Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia.
⁴ Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
⁵ Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia.
⁶ Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.

PMID: 39579500
DOI: 10.1016/j.clinbiomech.2024.106382

Abstract

Background: Diabetes-related foot ulcers pose substantial health risks globally, yet the biomechanical intricacies underlying their development remain incompletely understood. This study aimed to evaluate lower limb gait joint coordination variability in individuals with diabetes-related foot ulcers compared to those with diabetes (without diabetes-related foot ulcers) and healthy controls.

Methods: A total of 99 participants (diabetes-related foot ulcers cases - 16, Diabetes controls - 50, Health controls - 33) compared three self-paced walking trials. Vector coding, a technique quantifying movement coordination, was employed, analysing hip-knee, knee-ankle, and hip-angle joint couplings in the sagittal plane.

Findings: No significant differences in coordination variability were found among the groups. However, distinct coupling pattern frequencies emerged, with diabetes-related foot ulcers cases exhibiting unique anti-phase hip and ankle coupling frequency counts compared to healthy controls.

Interpretation: These findings challenge conventional understandings of diabetes-related foot ulcers biomechanics and underscore the complexity of gait in this population.

Keywords: Biomechanics; Diabetes-related foot disease; Foot ulceration; Gait; Peripheral neuropathy; Variability.