Static and Dynamic Predictors of Foot Progression Angle in Individuals with and without Diabetes Mellitus and Peripheral Neuropathy

Ericka N Merriwether, Mary K Hastings, Michael J Mueller, Kathryn L Bohnert, Michael J Strube, Darrah R Snozek, David R Sinacore

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Foot progression angle (FPA) is a predictor of elevated regional plantar stresses and loads, which are indicators of dermal injury risk in individuals with diabetes mellitus and peripheral neuropathy (DMPN). FPA accounts for 15-45% of the variance in plantar stresses and loads in adults with DMPN. However, the biomechanical factors underlying an "out-toeing" gait pattern in this clinical population have not been examined. The primary purpose of this study was to identify static and dynamic predictors of foot progression angle magnitude in adults with and without DMPN.

METHODS: Thirty-three adults with and 12 adults without diabetes mellitus participated. Hip rotation, ankle dorsiflexion, and resting calcaneal stance position were measured using a standard goniometer. Kinematic and kinetic data were collected during walking.

RESULTS AND DISCUSSION: Static predictor variables did not significantly predict foot progression angle magnitude using multiple regression analysis. Of the dynamic predictor variables, thigh and shank lateral rotation accounted for 37% of foot progression angle variance (p<.01).

CONCLUSIONS: Our results show that dynamic measures of external rotation of proximal segments (thigh, shank) during gait are strong predictors of foot progression angle. Static measures of limited joint mobility and joint position do not predict foot progression angle. These findings suggest that targeting the thigh and shank rotation using verbal or tactile cueing may be a potential strategy when trying to alter walking movement patterns towards decreasing external (lateral) FPA to minimize risk of elevated regional plantar stresses in adults with DMPN at risk for ulceration.

Original languageEnglish (US)
JournalAnnals of gerontology and geriatric research
Volume3
Issue number2
StatePublished - 2016

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Peripheral Nervous System Diseases
Foot
Diabetes Mellitus
Thigh
Gait
Walking
Joints
Touch
Biomechanical Phenomena
Ankle
Hip
Regression Analysis
Skin
Wounds and Injuries
Population

Keywords

  • Journal Article

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Static and Dynamic Predictors of Foot Progression Angle in Individuals with and without Diabetes Mellitus and Peripheral Neuropathy. / Merriwether, Ericka N; Hastings, Mary K; Mueller, Michael J; Bohnert, Kathryn L; Strube, Michael J; Snozek, Darrah R; Sinacore, David R.

In: Annals of gerontology and geriatric research, Vol. 3, No. 2, 2016.

Research output: Contribution to journalArticle

Merriwether, Ericka N ; Hastings, Mary K ; Mueller, Michael J ; Bohnert, Kathryn L ; Strube, Michael J ; Snozek, Darrah R ; Sinacore, David R. / Static and Dynamic Predictors of Foot Progression Angle in Individuals with and without Diabetes Mellitus and Peripheral Neuropathy. In: Annals of gerontology and geriatric research. 2016 ; Vol. 3, No. 2.
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T1 - Static and Dynamic Predictors of Foot Progression Angle in Individuals with and without Diabetes Mellitus and Peripheral Neuropathy

AU - Merriwether, Ericka N

AU - Hastings, Mary K

AU - Mueller, Michael J

AU - Bohnert, Kathryn L

AU - Strube, Michael J

AU - Snozek, Darrah R

AU - Sinacore, David R

PY - 2016

Y1 - 2016

N2 - INTRODUCTION: Foot progression angle (FPA) is a predictor of elevated regional plantar stresses and loads, which are indicators of dermal injury risk in individuals with diabetes mellitus and peripheral neuropathy (DMPN). FPA accounts for 15-45% of the variance in plantar stresses and loads in adults with DMPN. However, the biomechanical factors underlying an "out-toeing" gait pattern in this clinical population have not been examined. The primary purpose of this study was to identify static and dynamic predictors of foot progression angle magnitude in adults with and without DMPN.METHODS: Thirty-three adults with and 12 adults without diabetes mellitus participated. Hip rotation, ankle dorsiflexion, and resting calcaneal stance position were measured using a standard goniometer. Kinematic and kinetic data were collected during walking.RESULTS AND DISCUSSION: Static predictor variables did not significantly predict foot progression angle magnitude using multiple regression analysis. Of the dynamic predictor variables, thigh and shank lateral rotation accounted for 37% of foot progression angle variance (p<.01).CONCLUSIONS: Our results show that dynamic measures of external rotation of proximal segments (thigh, shank) during gait are strong predictors of foot progression angle. Static measures of limited joint mobility and joint position do not predict foot progression angle. These findings suggest that targeting the thigh and shank rotation using verbal or tactile cueing may be a potential strategy when trying to alter walking movement patterns towards decreasing external (lateral) FPA to minimize risk of elevated regional plantar stresses in adults with DMPN at risk for ulceration.

AB - INTRODUCTION: Foot progression angle (FPA) is a predictor of elevated regional plantar stresses and loads, which are indicators of dermal injury risk in individuals with diabetes mellitus and peripheral neuropathy (DMPN). FPA accounts for 15-45% of the variance in plantar stresses and loads in adults with DMPN. However, the biomechanical factors underlying an "out-toeing" gait pattern in this clinical population have not been examined. The primary purpose of this study was to identify static and dynamic predictors of foot progression angle magnitude in adults with and without DMPN.METHODS: Thirty-three adults with and 12 adults without diabetes mellitus participated. Hip rotation, ankle dorsiflexion, and resting calcaneal stance position were measured using a standard goniometer. Kinematic and kinetic data were collected during walking.RESULTS AND DISCUSSION: Static predictor variables did not significantly predict foot progression angle magnitude using multiple regression analysis. Of the dynamic predictor variables, thigh and shank lateral rotation accounted for 37% of foot progression angle variance (p<.01).CONCLUSIONS: Our results show that dynamic measures of external rotation of proximal segments (thigh, shank) during gait are strong predictors of foot progression angle. Static measures of limited joint mobility and joint position do not predict foot progression angle. These findings suggest that targeting the thigh and shank rotation using verbal or tactile cueing may be a potential strategy when trying to alter walking movement patterns towards decreasing external (lateral) FPA to minimize risk of elevated regional plantar stresses in adults with DMPN at risk for ulceration.

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