Foot Biomechanics in Patients with Diabetes Mellitus Doubts Regarding the Relationship Between Neuropathy, Foot Motion, and Deformities
Foot Biomechanics in Patients with Diabetes Mellitus Doubts Regarding the Relationship Between Neuropathy, Foot Motion, and Deformities
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DOI：
10.7547/1010208
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发表时间：
2011-05-01
影响因子：
0.7
通讯作者：
Martinez Hernandez, David
中科院分区：
文献类型：
--
作者：
Luis Lazaro-Martinez, Jose;Javier Aragon-Sanchez, Francisco;Martinez Hernandez, David
背景：通过测定糖尿病患者足的关节活动度、骨痂和足部畸形的存在和位置，探讨糖尿病患者足部的生物力学特征及其与糖尿病神经病变的关系。方法：对281例糖尿病患者进行神经和血管检查，进行观察性对比研究。进行关节活动度检查，并对畸形和角化过度的部位进行评估。结果：有神经病变和无神经病变的患者在关节活动度范围上没有显著差异。神经病变仅在第一跖趾关节被动活动范围内被视为危险因素(平均+/-SD：57.2度+/-19.5度对50.3度+/-22.5度，P=0.008)。两组患者的平均+/-SD踝关节活动度值相似(83.0度+/-5.2度对82.8度+/-9.3度，P=.826)。无神经病变的患者足部畸形的发生率较高，如拇指、外展、外翻和锤状趾。在无神经病变的患者中，骨痂的发生率也较高(82.8%比72.6%；P=.039)。结论：糖尿病神经病变与关节活动受限和骨痂的存在无关。患有神经病的患者没有表现出任何畸形的更高风险。这些发现表明，糖尿病患者生物力学改变的病因是复杂的，可能涉及几个解剖和病理易感因素。(足科医学协会会刊101(3)：208-214,2011)
Background: We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities.Methods: This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed.Results: No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean +/- SD: 57.2 degrees +/- 19.5 degrees versus 50.3 degrees +/- 22.5 degrees, P = .008). Mean +/- SD ankle joint mobility values were similar in both groups (83.0 degrees +/- 5.2 degrees versus 82.8 degrees +/- 9.3 degrees, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039).Conclusions: Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors. (J Am Podiatr Med Assoc 101(3): 208-214, 2011)