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(Reference retrieved automatically from Web of Science through information on FAPESP grant and its corresponding number as mentioned in the publication by the authors.)

Impact of diabetic neuropathy severity on foot clearance complexity and variability during walking

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Suda, Eneida Yuri [1] ; Matias, Alessandra Bento [1] ; Bus, Sicco A. [2] ; Sacco, Isabel C. N. [1]
Total Authors: 4
[1] Univ Sao Paulo, Sch Med, Speech & Occupat Therapy Dept, Phys Therapy, Sao Paulo - Brazil
[2] Univ Amsterdam, Rehabil, Amsterdam Movement Sci, Amsterdam UMC, Meibergdreef 9, Amsterdam - Netherlands
Total Affiliations: 2
Document type: Journal article
Source: GAIT & POSTURE; v. 74, p. 194-199, OCT 2019.
Web of Science Citations: 0

Background: The control of foot trajectory during swing phase is important to achieve safe clearance with the ground. Complexity of a physiological control system arises from the interaction of structural units and regulatory feedback loops that operate to enable the organism to adapt to a non-static environment. Diabetic polyneuropathy (DPN) impairs peripheral feedback inputs and alters ankle control during gait, which might affect toe clearance (ToC) parameters and its complexity, predisposing DPN-subjects to tripping and falling. Research question: How do different DPN-severity degrees change ToC trajectory and minimum ToC, and its complexity during gait of diabetic subjects? Methods: 15 healthy controls and 69 diabetic subjects were assessed and classified into DPN-severity degrees by an expert fuzzy model: absent (n = 26), mild (n = 21) and severe (n = 22). Three-dimensional kinematics was measured during comfortable walking. ToC was the minimum vertical distance between the marker placed at the first metatarsal head and the ground during swing. Mean ToC, ToC standard deviation (SD) between trials, and sample entropy (SaEn) and standard deviation (SD) of ToC trajectory were calculated from the ToC temporal series. ANOVA and ANCOVA (with the walking speed as the covariate) and Bonferroni pairwise post-hoc tests (P < 0.05) were used to compare groups. Results: Mean ToC and ToC SD did not show differences between groups (ANCOVA F = 0.436; df = 3; P = 0.705; F = 1.719; df = 3; P = 0.170, respectively). ToC trajectory SD also did not show differences between groups (ANCOVA F = 3.98; df = 3; P = 0.755). Severe-DPN subjects showed higher ToC\_Traj\_SaEn than controls (ANCOVA F = 2.60; df = 3; P = 0.05). Significance: Severe-DPN subjects showed a more complex pattern of overall foot-ankle trajectory in swing phase in comparison to controls, although did not present lower minimum ToC values. The higher complexity of ToC might lead to an increase in the motor system output (more strategies, increase in variability), resulting in a more unstable system and selected motor strategies. (AU)

FAPESP's process: 17/15449-4 - Biomechanical and functional aspects of the musculoskeletal system of runners: chronic effects of therapeutic exercise and aging
Grantee:Eneida Yuri Suda
Support type: Scholarships in Brazil - Post-Doctorate
FAPESP's process: 16/17077-4 - Effects of a foot and ankle complex strengthening program on the occurrence of injuries and biomechanics in long distance runners: a controlled, randomized clinical trial
Grantee:Alessandra Bento Matias
Support type: Scholarships in Brazil - Doctorate (Direct)