• 1

    Saeedi P, Salpea P, Karuranga S, et al: Mortality attributable to diabetes in 20–79 years old adults, 2019 estimates: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 162: 108086, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Armstrong DG, Boulton AJ, Bus SA: Diabetic foot ulcers and their recurrence. N Engl J Med 376: 2367, 2017.

  • 3

    Tesfaye S, Vileikyte L, Rayman G, et al: Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res 27: 629, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Lazzarini PA, Pacella RE, Armstrong DG, et al: Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabet Med 35: 1297, 2018.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Hampton K, Alani S, Wilson J, et al: Resistance to ischaemic conduction failure in chronic hypoxaemia and diabetes. J Neurol Neurosurg Psychiatry 52: 1303, 1989.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Boulton A, Armstrong D, Albert S, et al: Comprehensive foot examination and risk assessment. Endocr Pract 14: 576, 2008.

  • 7

    Lazzarini PA, Crews RT, van Netten JJ, et al: Measuring plantar tissue stress in people with diabetic peripheral neuropathy: a critical concept in diabetic foot management. J Diabetes Sci Technol 13: 869, 2019.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Sacco I, Hamamoto A, Gomes A, et al: Role of ankle mobility in foot rollover during gait in individuals with diabetic neuropathy. Clin Biomech 24: 687, 2009.

  • 9

    Armstrong DG, Stacpoole-Shea S, Nguyen H, 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Barry D, Sabacinski K, Habershaw G, et al: Tendo Achillis procedures for chronic ulcerations in diabetic patients with transmetatarsal amputations. JAPMA 83: 96, 1993.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Hastings MK, Mueller MJ, Sinacore DR, et al: Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus. J Orthop Sport Phys 30: 85, 2000.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Lin SS, Lee TH, Wapner KL: 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Mueller MJ, Diamond JE, Delitto A, et al: Insensitivity, limited joint mobility, and plantar ulcers in patients with diabetes mellitus. Phys Ther 69: 453, 1989.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Wyatt LH, Ferrance RJ: The musculoskeletal effects of diabetes mellitus. J Can Chiropr Assoc 50: 43, 2006.

  • 15

    Boulton AJ, Hardisty CA, Betts RP, et al: Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care 6: 26, 1983.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Caselli A, Pham H, Giurini JM, 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Fernando DJ, Masson EA, Veves A, et al: Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care 14: 8, 1991.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Veves A, Murray H, Young M, et al: The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia 35: 660, 1992.

  • 19

    Abate M, Schiavone C, Salini V, et al: Management of limited joint mobility in diabetic patients. Diabetes Metab Syndr Obes 6: 197, 2013.

  • 20

    Gerrits EG, Landman GW, Nijenhuis-Rosien L, et al: Limited joint mobility syndrome in diabetes mellitus: a minireview. World J Diabetes 6: 1108, 2015.

  • 21

    Amemiya A, Noguchi H, Oe M, et al: Elevated plantar pressure in diabetic patients and its relationship with their gait features. Gait Posture 40: 408, 2014.

  • 22

    Searle A, Spink M, Chuter V: Prevalence of ankle equinus and correlation with foot plantar pressures in people with diabetes. Clin Biomech 60: 39, 2018.

  • 23

    Turner D, Helliwell PS, Burton AK, et al: The relationship between passive range of motion and range of motion during gait and plantar pressure measurements. Diabet Med 24: 1240, 2007.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Zhang Q, Yi N, Liu S, et al: Easier operation and similar power of 10 g monofilament test for screening diabetic peripheral neuropathy. J Intern Med Res 46: 3278, 2018.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Armstrong DG, Lavery LA, Vela SA, et al: Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med 158: 289, 1998.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Rabin A, Kozol Z: Weightbearing and nonweightbearing ankle dorsiflexion range of motion: are we measuring the same thing? JAPMA 102: 406, 2012.

  • 27

    Searle A, Spink M, Chuter V: Weight bearing versus non-weight bearing ankle dorsiflexion measurement in people with diabetes: a cross sectional study. BMC Musculoskel Dis 19: 1, 2018.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Menz HB, Tiedemann A, Kwan MM-S, et al: Reliability of clinical tests of foot and ankle characteristics in older people. JAPMA 93: 380, 2003.

  • 29

    Hopson MM, McPoil T, Cornwall MW: Motion of the first metatarsophalangeal joint. Reliability and validity of four measurement techniques. JAPMA 85: 198, 1995.

  • 30

    Sánchez-Gómez R, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, et al: Reliability study of diagnostic tests for functional hallux limitus. Foot Ankle Int 41: 457, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Stevens JP: Applied Multivariate Statistics for the Social Sciences, Routledge, Philadelphia, 2012.

  • 32

    Menz HB: Two feet, or one person? problems associated with statistical analysis of paired data in foot and ankle medicine. Foot 14: 2, 2004.

  • 33

    Cohen J: Statistical Power Analysis for the Behavioral Sciences, 2nd Ed, p 13, Lawrence Erlbaum Associates Inc, Hillsdale, NJ, 1988.

  • 34

    Searle A, Spink MJ, Chuter VH: Validation of a weight bearing ankle equinus value in older adults with diabetes. J Foot Ankle Res 11: 1, 2018.

  • 35

    Joseph J: Range of movement of the great toe in men. J Bone Joint Surg Br 36: 450, 1954.

  • 36

    Tang UH, Zügner R, Lisovskaja V, et al: Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers. Diabet Foot Ankle 6: 27593, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Thornalley PJ: Glycation in diabetic neuropathy: characteristics, consequences, causes, and therapeutic options. Int Rev Neurobiol 50: 37, 2002.

  • 38

    Williams DB, Brunt D, Tanenberg RJ: Diabetic neuropathy is related to joint stiffness during late stance phase. J Appl Biomech 23: 251, 2007.

  • 39

    Searle A, Spink MJ, Oldmeadow C, et al: Calf muscle stretching is ineffective in increasing ankle range of motion or reducing plantar pressures in people with diabetes and ankle equinus: a randomised controlled trial. Clin Biomech 69: 52, 2019.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Gedebjerg A, Almdal TP, Berencsi K, et al: Prevalence of micro-and macrovascular diabetes complications at time of type 2 diabetes diagnosis and associated clinical characteristics: a cross-sectional baseline study of 6958 patients in the Danish DD2 cohort. J Diabetes Complications 32: 34, 2018.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Fang M: Trends in the prevalence of diabetes among US adults: 1999–2016. Am J Prev Med 55: 497, 2018.

  • 42

    Sainsbury E, Shi Y, Flack J, et al: Burden of diabetes in Australia: its time for more action. Available at: https://www.sydney.edu.au/content/dam/corporate/documents/faculty-of-medicine-and-health/research/centres-institutes-groups/burden-of-diabetes-its-time-for-more-action-report.pdf.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Butterworth PA, Urquhart DM, Landorf KB, et al: Foot posture, range of motion and plantar pressure characteristics in obese and non-obese individuals. Gait Posture 41: 465, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Mayfield JA, Sugarman JR: The use of the Semmes-Weinstein monofilament and other threshold tests for preventing foot ulceration and amputation in persons with diabetes. J Fam Pract 49: S17, 2000.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Singh N, Armstrong DG, Lipsky BA: Preventing foot ulcers in patients with diabetes. JAPMA 293: 217, 2005.

  • 46

    Young MJ, Breddy JL, Veves A, et al: The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds: a prospective study. Diabetes Care 17: 557, 1994.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    Ibrahim A: IDF clinical practice recommendation on the diabetic foot: a guide for healthcare professionals. Diabetes Res Clin Pract 127: 285, 2017.

  • 48

    Pop-Busui R, Boulton AJ, Feldman EL, et al: Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 40: 136, 2017.

  • 49

    Schaper NC, van Netten JJ, Apelqvist J, et al: Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev 36: e3266, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50

    Halstead J, Redmond AC: Weight-bearing passive dorsiflexion of the hallux in standing is not related to hallux dorsiflexion during walking. J Orthop Sports Phys Ther 36: 550, 2006.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51

    Gatt A, Chockalingam N: Clinical assessment of ankle joint dorsiflexion: a review of measurement techniques. JAPMA 101: 59, 2011.

  • 52

    Kim PJ, Peace R, Mieras J, et al: Interrater and intrarater reliability in the measurement of ankle joint dorsiflexion is independent of examiner experience and technique used. JAPMA 101: 407, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53

    Baumbach SF, Brumann M, Binder J, et al: The influence of knee position on ankle dorsiflexion: a biometric study. BMC Musculoskelet Disord 15: 246, 2014.

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

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 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 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 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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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 A1c 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. 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%. Diabetes-related peripheral neuropathy (DPN) affects approximately 30% to 50% of people with diabetes and is one of the most significant risk factors for the development of DFU and amputation. Diabetes-related peripheral neuropathy occurs as a result of neural ischemia and perineural edema causing neural demyelination, affecting nerve conductivity. 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.,

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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