advertising
-
1.
Boulton, AJ, RP Betts, CI Franks, et al. :Abnormalities of foot pressure in early diabetic neuropathy. .Diabet Med 4::225. ,1987. .
-
2.
Pecaroro, RE, GE Reiber, and EM Burgess. :Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .
-
3.
Birke, JA, BD Franks, and JG Foto. :First ray joint limitation, pressure, and ulceration of the first metatarsal head in diabetes mellitus. .Foot Ankle Int 16::277. ,1995. .
-
4.
Lavery, LA, DG Armstrong, and AJ Boulton. ;Diabetes Research Group :Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. .JAPMA 92::479. ,2002. .
-
5.
Quebedeaux, TL, LA Lavery, and DC Lavery. :The development of foot deformity and ulcers after great toe amputation in diabetes. .Diabetes Care 19::165. ,1996. .
-
6.
Veves, A, HJ Murray, MJ Young, et al. :The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. .Diabetologia 35::660. ,1992. .
-
7.
Root, ML, WP Orien, and JH Weed. : “Forces Acting upon the Foot During Locomotion: Abnormal Motion of the Foot. ,” inNormal and Abnormal Function of the Foot, Clinical Biomechanics. , Vol2:, pp165––179. ,295. ,Clinical Biomechanics Corp. ,Los Angeles. ,1977. .
-
8.
Van Gils, CC and B Roeder. :The effect of ankle equinus upon the diabetic foot. .Clin Podiatr Med Surg 19::391. ,2002. .
-
9.
Downey, MS . : “Ankle Equinus. ,” inComprehensive Textbook of Foot Surgery. , Vol1:, p715. ,Lippincott Williams & Wilkins. ,Philadelphia. ,2001. .
-
10.
Oredurf, MS, ES Rohr, BJ Sangeorzan, et al. :An equinus deformity of the ankle accounts for only a small amount of the increased forefoot plantar pressure in patients with diabetes. .J Bone Joint Surg Br 88::65. ,2006. .
-
11.
Guyton, GP and CL Saltzman. :The diabetic foot: basic mechanisms of disease. .J Bone Joint Surg Am 83::1083. ,2001. .
-
12.
Boffeli, TJ, JK Bean, and JR Natwick. :Biomechanical abnormalities and ulcers of the great toe in patients with diabetes. .J Foot Ankle Surg 41::359. ,2002. .
-
13.
Gatt, A and N Chockalingam. :Clinical assessment of ankle joint dorsiflexion: a review of measurement techniques. .JAPMA 101::59. ,2011. .
-
14.
Caselli, A, H Pham, JM Giurini, et al. :The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. .Diabetes Care 25::1066. ,2002. .
-
15.
Mueller, MJ, SD Minor, SA Sahrmann, et al. :Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. .Phys Ther 74::299. ,1994. .
-
16.
Luger, E, M Nissan, A Karpf, et al. :Dynamic pressures on the diabetic foot. .Foot Ankle Int 22::715. ,2001. .
-
17.
Grant, WP, EJ Foreman, AS Wilson, et al. :Evaluation of Young’s modulus in Achilles tendons with diabetic neuroarthropathy. .JAPMA 95::242. ,2005. .
-
18.
Lin, SS, TH Lee, and KL Wapner. :Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo-Achilles lengthening and total contact casting. .Orthopedics 19::465. ,1996. .
-
19.
Hill, RS . :Ankle equinus: prevalence and linkage to common foot pathology. .JAPMA 85::295. ,1995. .
-
20.
Grant, WP, R Sullivan, DE Sonenshine, et al. :Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. .J Foot Ankle Surg 36::272. ,1997. .
-
21.
D’Ambrogi, E, L Giurato, MA D’Agostino, et al. :Contribution of plantar fascia to the increased forefoot pressures in diabetic patients. .Diabetes Care 26::1525. ,2003. .
-
22.
Frykberg, RG, LA Lavery, H Pham, et al. :Role of neuropathy and high foot pressures in diabetic foot ulcerations. .Diabetes Care 21::1714. ,1998. .
-
23.
Donnery, J and RB Spencer. :The biplane goniometer: a new device for measurement of ankle dorsiflexion. .JAPMA 78::348. ,1988. .
-
24.
Fernando, DJS, EA Masson, A Veves, et al. :Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. .Diabetes Care 14::8. ,1991. .
-
25.
Armstrong, DG, S Stacpoole-Shea, H Nguyen, et al. :Lengthening of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot. .J Bone Joint Surg Am 81::535. ,1999. .
-
26.
DiGiovanni, CW, R Kuo, N Tejwani, et al. :Isolated gastrocnemius tightness. .J Bone Joint Surg Am 84::962. ,2002. .
Prevalence of Equinus in Diabetic versus Nondiabetic Patients
Arizona Podiatric Medicine Program, Midwestern University College of Health Sciences, Glendale, AZ.
Search for other papers by Robert G. Frykberg in
Current site
Google Scholar
PubMed
Arizona Podiatric Medicine Program, Midwestern University College of Health Sciences, Glendale, AZ.
Search for other papers by Joel Bowen in
Current site
Google Scholar
PubMed
Search for other papers by Jared Hall in
Current site
Google Scholar
PubMed
Search for other papers by Arthur Tallis in
Current site
Google Scholar
PubMed
Arizona Podiatric Medicine Program, Midwestern University College of Health Sciences, Glendale, AZ.
Search for other papers by Edward Tierney in
Current site
Google Scholar
PubMed
Arizona Podiatric Medicine Program, Midwestern University College of Health Sciences, Glendale, AZ.
Search for other papers by Denise Freeman in
Current site
Google Scholar
PubMed
Background:
There are no conclusive data to support the contention that diabetic patients have an increased frequency of ankle equinus compared with their nondiabetic counterparts. Additionally, a presumed contributing cause of foot ulceration is ankle joint equinus. Therefore, we sought to determine whether persons with diabetes have a higher prevalence of ankle joint equinus than do nondiabetic persons.
Methods:
A prospective pilot survey of 102 outpatients (43 diabetic and 59 nondiabetic) was conducted. Demographic and historical data were obtained. Each patient underwent a standard lower-extremity examination, including the use of a biplane goniometer to measure ankle joint range of motion.
Results:
Equinus, defined as ankle dorsiflexion measured at 0° or less, was found in 24.5% of the overall population. In the diabetes cohort, 16 of 43 patients (37.2%) were affected compared with 9 of 59 nondiabetic participants (15.3%) (P = .011). There was a threefold risk of equinus in the diabetic population (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.28–8.44; P < .013). The equinus group had a history of ulceration in 52.0% compared with 20.8% of the nonequinus group (P = .003). Equinus, therefore, imparted a fourfold risk of ulceration (OR, 4.13; 95% CI, 1.58–10.77; P < .004). We also found a 2.8 times risk of equinus in patients with peripheral neuropathy (OR, 2.8; 95% CI, 1.11–7.09; P < .029).
Conclusions:
Equinus may be more prevalent in diabetic patients than previously reported. Although we cannot prove causality, we found a significant association between equinus and ulceration. (J Am Podiatr Med Assoc 102(2): 84–88, 2012)
advertising
