Relationship Between Diabetes-Related Large-Fiber Neuropathy and Dorsiflexion Range of Motion at the Ankle and First Metatarsophalangeal Joints

Ally Maree McIllhatton; Sean Michael Lanting; Sean George Sadler; Vivienne Helaine Chuter

doi:10.7547/21-097

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Journal of the American Podiatric Medical Association

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Online Publication Date:: Nov 2023

Relationship Between Diabetes-Related Large-Fiber Neuropathy and Dorsiflexion Range of Motion at the Ankle and First Metatarsophalangeal Joints

Ally Maree McIllhatton

Ally Maree McIllhatton School of Health Sciences, College of Health, Medicine, and Wellbeing, University of Newcastle, Ourimbah, NSW, Australia.

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Sean Michael Lanting

Sean Michael Lanting School of Health Sciences, Western Sydney University, B24.2.65, Narellan Rd & Gilchrist Dr, Campbelltown NSW 2560, Australia.

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Sean George Sadler

Sean George Sadler School of Health Sciences, Western Sydney University, B24.2.65, Narellan Rd & Gilchrist Dr, Campbelltown NSW 2560, Australia.

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Vivienne Helaine Chuter

Vivienne Helaine Chuter School of Health Sciences, College of Health, Medicine, and Wellbeing, University of Newcastle, Ourimbah, NSW, Australia.
School of Health Sciences, Western Sydney University, B24.2.65, Narellan Rd & Gilchrist Dr, Campbelltown NSW 2560, Australia.

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DOI:: https://doi.org/10.7547/21-097

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Background: Diabetes-related peripheral neuropathy (DPN) and limited joint mobility of the foot and ankle are implicated in the development of increased plantar pressures and diabetes-related foot ulcers. The extent of this relationship has not been conclusively established. We aimed to determine the relationship between ankle joint and first metatarsophalangeal joint dorsiflexion range of motion and DPN using a cross-sectional observational study design.

Methods: Primary outcomes were DPN status, ankle joint range of motion (extended and flexed knee lunge tests), and nonweightbearing first metatarsophalangeal joint range of motion. Correlations were performed using Pearson r, and hierarchical regression analyses were undertaken to determine the independent contribution of DPN to the variance in dorsiflexion range of motion of ankle and first metatarsophalangeal joints using standardized β regression coefficients, controlling for age, sex, body mass index, diabetes duration, and hemoglobin A_1c level.

Results: One hundred one community-dwelling participants (mean ± SD age, 65.0 ± 11.2 years; 55 men; 97% type 2 diabetes; mean ± SD diabetes duration, 8.7 ± 7.8 years; 23% with DPN) were recruited. Diabetes-related peripheral neuropathy demonstrated significant correlations with reduced range of motion at the ankle joint (knee extended: r = –0.53; P < .001 and knee flexed: r = –0.50; P < .001) and the first metatarsophalangeal joint (r = –0.37; P < .001). Also, DPN made significant, unique contributions to the regression models for range of motion at the ankle joint (knee extended: r² change = 0.121; β = –0.48; P < .001 and knee flexed: r² change = 0.109; β = –0.45; P < .001) and first metatarsophalangeal joint (r² change = 0.037; β = –0.26; P = .048).

Conclusions: These findings suggest that DPN contributes to reduced ankle and first metatarsophalangeal joint range of motion. Due to the established link between reduced ankle and first metatarsophalangeal joint range of motion and risk of diabetes-related foot ulcer, we recommend that clinicians assess dorsiflexion range of motion at these joints as part of routine foot assessment in people with diabetes, especially those with DPN.

Globally, approximately 436 million adults aged 20 to 79 years are living with diabetes.¹ Diabetes is the leading cause of lower-limb amputation and is associated with a lifetime incidence of diabetes-related foot ulcer (DFU) of up to 34%.² Diabetes-related peripheral neuropathy (DPN) affects approximately 30% to 50% of people with diabetes³ and is one of the most significant risk factors for the development of DFU and amputation.⁴ Diabetes-related peripheral neuropathy occurs as a result of neural ischemia and perineural edema causing neural demyelination, affecting nerve conductivity.⁵ In the presence of DPN, intrinsic foot muscle wasting can lead to the development of foot deformities such as digital clawing, which, when coupled with structural and functional changes to the skin, make it less resistant to shear forces and further increase plantar pressure and risk of DFU.⁶ ^, ⁷

Corresponding author: Sean Michael Lanting, PhD, School of Health Sciences, College of Health, Medicine, and Wellbeing, The University of Newcastle, Room BE152, 10 Chittaway Rd, Ourimbah NSW 2258, Australia. (E-mail: sean.lanting@newcastle.edu.au)

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Relationship Between Diabetes-Related Large-Fiber Neuropathy and Dorsiflexion Range of Motion at the Ankle and First Metatarsophalangeal Joints

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