Foot Progression Angle in Individuals with Diabetes & Peripheral Neuropathy

描述（由申请人提供）：本研究的长期目标是确定足部进展角（FPA）对糖尿病和周围神经病变（DMPN）成人神经性足底溃疡发展的贡献，FPA是一个空间步态变量，代表足部在横向平面上的旋转。临床意义：在美国，每年大约有80,000例非创伤性下肢截肢，其中84%的截肢术前有神经性足底溃疡。患有DMPN的成人患神经性足底溃疡的风险很高，继发于无感觉足骨突出处足底压力峰值增加。因此，足底压力峰值经常被用作衡量皮肤破裂和随后非创伤性下肢截肢风险的替代指标。初步研究表明，在患有神经病理学的儿童和患有DMPN的成人中，过度的外部FPA与内侧足底压力峰值的时间和大小之间存在直接关系。考虑到患有DMPN的成年人与下肢损伤相关的功能活动障碍的比率几乎是健康同龄人的三倍，我们有必要提高我们对过度的外部FPA对过度内侧峰值足底压力、内侧神经性足底溃疡和非创伤性下肢截肢等损伤级联的贡献的理解。未开发的研究领域：尽管过度的外部FPA与足底压力之间存在很强的关系，但据我们所知，还没有研究调查了DMPN患者的关节活动限制是否会导致FPA。此外，没有研究探讨是否可以减少DMPN成人患者过度的外部FPA，从而为非创伤性下肢截肢损伤级联的早期康复干预创造潜在的策略。我们提出的研究旨在提高对导致DMPN成人外部FPA强度增加的特定运动障碍的理解，以及这些障碍是否适合早期干预。目的1：确定糖尿病无周围神经病变（仅DM）、糖尿病无糖尿病（CON）、糖尿病伴周围神经病变伴神经性足底溃疡（DMPN [+] NPU）、糖尿病伴周围神经病变伴神经性足底溃疡（DMPN [-] NPU）三组受试者的FPA特征。目的2：确定选择下肢关节变量预测FPA大小的能力；目的3：确定降低FPA对FPA过大的糖尿病患者内侧足底压力峰值的影响。预期结果：我们假设足部、踝关节和髋关节运动受限是导致成人DMPN患者外FPA过大的主要原因。我们还假设，在接受指导后，DMPN的参与者可以有意地降低FPA，从而导致内侧足底压力峰值降低。

DESCRIPTION (provided by applicant): The long-term objective of this research is to determine the contribution of foot progression angle (FPA), a spatial gait variable that represents foot rotation in the transverse plane, to the development of neuropathic plantar ulcers in adults with diabetes mellitus and peripheral neuropathy (DMPN). Clinical Significance: There are approximately 80,000 non-traumatic lower extremity amputations annually in the United States, 84% of which are preceded by neuropathic plantar ulcers. Adults with DMPN are at high risk for neuropathic plantar ulceration secondary to increased peak plantar pressure under bony prominences on an insensate foot. Therefore, peak plantar pressure is frequently used as a proxy measure of risk for skin breakdown and subsequent non-traumatic lower extremity amputation. Preliminary studies suggest a direct relationship between excessive external FPA and the timing and magnitude of medial peak plantar pressure in children with neurological pathology and in adults with DMPN. Given that adults with DMPN have nearly three times the rate of functional mobility deficits associated with lower extremity impairment than their healthy counterparts, it is imperative to improve our understanding of the contribution of excessive external FPA to the impairment cascade of excessive medial peak plantar pressures, medial neuropathic plantar ulceration, and non-traumatic lower extremity amputation. Unexplored areas of research: Despite the strong relationship between excessive external FPA and plantar pressure, to our knowledge there are no studies that have examined joint mobility limitations that contribute to FPA in individuals with DMPN. Furthermore, there are no studies probing whether excessive external FPA can be reduced in adults with DMPN, thereby creating a potential strategy for early rehabilitation intervention in the non-traumatic lower extremity amputation impairment cascade. Our proposed research seeks to improve understanding of specific movement impairments that contribute to increased external FPA magnitude in adults with DMPN, and if those impairments are amenable to early intervention. Aim 1: Determine the characteristics of FPA in groups of subjects with diabetes mellitus without peripheral neuropathy (DM only), without diabetes mellitus (CON), with diabetes mellitus and peripheral neuropathy WITH a history of neuropathic plantar ulcers (DMPN [+] NPU), and with diabetes mellitus and peripheral neuropathy WITHOUT a history of neuropathic plantar ulcers (DMPN [-] NPU). Aim 2: Determine ability of select lower extremity joint variables to predict FPA magnitude; Aim 3: Determine the effect of reducing FPA on medial peak plantar pressure in individuals with diabetes with excessive FPA magnitude. Expected outcomes: We hypothesize that foot, ankle, and hip joint motion limitations contribute substantially to excessive external FPA magnitude in adults with DMPN. We also hypothesize that after instruction, participants with DMPN can intentionally reduce their FPA, resulting in concomitant decreases in medial peak plantar pressure. PUBLIC HEALTH RELEVANCE: Knowledge gained from these findings will clarify our understanding of risk factors for the development of a region-specific foot ulcer, an impairment associated with non-traumatic lower extremity amputation, in individuals with diabetes across a broad spectrum of disease severity. Furthermore, we will determine the impact of risk factor modification on pressure variables that serve as indices of risk for foot ulcer development using non-invasive, cost-effective intervention strategies.