Foot pressures, peripheral neuropathy, and joint mobility in asian and europid patients with diabetes 

Objective. A cross sectional study was developed to investigate ethnic differences in foot pressure and joint mobility in non-diabetic and diabetic subjects with and without neuropathy in a hospital-based diabetes clinic.

METHODS

The subject groups consisted of a volunteer sample of 10 Asians (AC), 11 Europid non-diabetic controls (C), a consecutive sample of 12 Asians (ADC) and 11 Europid (DC) non-neuropathic patients, and 12 Asian (ADN) and 13 Europid (DN) neuropathic diabetic patients. All subjects were matched with respect to age and gender. The main outcome measures were foot pressures and joint mobility.

RESULTS

Peak foot pressure was increased in DN (1150 ± 412 kPa, mean ± SD) compared to AC, ADC, ADN, C, and DC (510 ± 164 kPa, 673 ± 331 kPa, 623 ± 222 kPa, 707 ± 240 kPa, 793 ± 196 kPa, respectively; P < 0.05). Passive range of motion of the subtalar joint, ankle (AC only), first metatarsophalangeal and fifth metacarpophalangeal joints (MCJP) were reduced in DN compared to the Asian controls and diabetic patients (P < 0.05). Dynamic ankle and rearfoot (subtalar) joint angles were not different among groups. Only the fifth MCJP extension had an effect on peak plantar pressure while controlling for ethnicity (P < 0.05).

CONCLUSION

Peak foot pressure was higher and joint mobility was lower in Europid compared to Asian diabetic neuropathic patients; however, no relationship was observed between reduced foot joint mobility and increased foot pressures. The association between fifth MCJP extension and peak pressure suggest that fifth MCJP extension may be used as a screening method for increased pressure. The low foot pressures exhibited by the Asian subjects are most likely caused by factors other than those investigated in this study.

Knee kinematics in functional activities seven years after total knee arthroplasty

BACKGROUND

Detailed knowledge of knee kinematics during functional activities is lacking in current studies on the long-term outcome of total knee replacement surgery. The aim of this study was to assess functional knee kinematics using flexible electrogoniometry in patients seven years after unilateral primary total knee arthroplasty for osteoarthritis.

METHODS

The knee joint functional movement of a cohort of patients (n=19) with knee osteoarthritis was assessed using electrogoniometry before surgery and 18-24 months and seven years after total knee surgery. The mean age of the patients (11 women and 8 men) at the time of the pre-surgery assessment was 67 years old (SD 8.0). Patient function was also assessed using the Knee Society Score and WOMAC osteoarthritis Index.

FINDINGS

The function components of the Knee Society and WOMAC scores were significantly decreased at seven years compared to 18-24 months after surgery (both P<0.05). However, the majority of the functional knee flexion values derived from electrogoniometry did not decrease. Seven years after surgery, knee excursion during ascending and descending stairs was significantly improved compared to 18-24 months after surgery (both P<0.01).

INTERPRETATION

The finding that functional knee motion continues to improve between 18-24 months and seven years post-surgery is of interest to both patients and those responsible for their treatment planning. Further, it was shown that the WOMAC and Knee Society Scores do not follow the same trends as the patients' functional knee kinematics seven years after total knee replacement surgery.

Correlation of the Edinburgh Gait Score with the Gillette Gait Index, the Gillette Functional Assessment Questionnaire, and dimensionless speed

This study examines the correlation of the Edinburgh Gait Score (EGS) with the Gillette Gait Index (GGI; formerly the Normalcy Index), the Gillette Functional Assessment Questionnaire, and speed, all of which are used as measures of gait quality or function. Scores were computed for 58 subjects, all with a diagnosis of cerebral palsy. The correlation of the EGS with all of the other scores was found to be significant, with r2 ranging from 0.26 to 0.79. The strongest correlation was found with the GGI, which may reflect common features in the derivation of both of these scores, although the EGS was derived from observational gait analysis and the GGI from principal component analysis of variables from computerized 3-dimensional gait data. We conclude that the EGS shows good concurrent validity with alternative gait assessment scores.

Passive and dynamic rotation of the lower limbs in children with diplegic cerebral palsy

Rotation characteristics in gait and passive rotation of the lower limbs were evaluated retrospectively in 105 patients with diplegic cerebral palsy (65 males, 40 females; mean age 13y [SD 6y 9mo]; range 4y 4mo-40y 5mo). Of 105 patients, 22 (20.9%) required crutches, sticks, tripods, or a K-walker for their daily ambulation. Twelve (11.5%) patients used a wheelchair or buggy for community distances, e.g. shopping. Significant differences in rotational characteristics were found at the pelvis, hip, knee, and foot between left and right legs. Patients who were more affected on the right (group R, n=33) or the left side (group L, n=39) were re-evaluated. There was also a group of patients who were not asymmetrically affected (group S, n=33). In group L, maximum passive internal rotation was significantly greater on the left side, while no difference between the sides was found in group R. Peak internal rotation in gait was significantly higher on the right side in group R, but did not differ significantly between the sides in group L. Right hindfoot-thigh angle and transmalleolar axis were more external on the right, irrespective of which leg was more affected. These findings may have implications for the early non-operative management of limb posture in infants with diplegia and the surgical management of established lower extremity malrotation.

Test-Retest repeatability of gluteus maximus strength testing using a fixed digital dynamometer in children with cerebral palsy

OBJECTIVE

To investigate the test-retest repeatability of the measurement of the gluteus maximus strength using a fixed digital dynamometer.

DESIGN

Test-retest design. The strength of the gluteus maximus was measured in prone position during 2 sessions an average of 6 days apart.

SETTING

Gait analysis laboratory.

PARTICIPANTS

Eleven children with spastic diplegic (n=10) and hemiplegic (n=1) cerebral palsy (CP), age 6 to 14 years, and 11 aged-matched children. All were able to walk independently, but 2 in the CP group used walking aids.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

On 2 occasions, gluteus maximus strength was measured 3 times in 2 positions of the hip joint. Repeatability of the measurements was assessed by intraclass correlation coefficients (ICCs), coefficients of variation, and the coefficient of repeatability.

RESULTS

When normalized to body mass, children with CP had significantly less gluteus maximus strength compared with the controls. The ICCs for the control group ranged from .76 to .85 and from .75 to .83 for the involved leg in the CP group.

CONCLUSIONS

The reliability of measurement of gluteus maximus strength was good for both control group and the involved leg of the CP group. The normalized values for gluteus maximus strength and measures of reproducibility can be used when measuring gluteus maximus strength in children with CP.

Effects of surgical lengthening of the hamstrings without a concomitant distal rectus femoris transfer in ambulant patients with cerebral palsy

Eighteen ambulant patients (32 legs) who had undergone fractional lengthening of the medial and lateral hamstrings without rectus femoris transfer underwent pre- and postoperative gait analysis. A significant increase in the amount of knee extension and a decrease in the amount of peak knee flexion in swing were observed. This decrease in knee flexion signified a change towards more normal speed-related values. Dorsiflexion at initial contact decreased significantly for patients who did not undergo a gastrocnemius lengthening (n = 24). Absolute cadence was significantly lower after surgery, but the change in dimensionless cadence was not significantly different. This difference in the outcome between dimensionless and absolute stride parameters can be attributed to the increase in body height after surgery. The clinical significance of these findings is that it is important to recognize that postoperative effects of surgery on gait in children may, in part, be explained by changes in height and not surgery alone.

The mid-point of passive hip rotation range is an indicator of hip rotation in gait in cerebral palsy

This study investigated the strength of any linear relationship between femoral anteversion and passive hip rotations, with rotation of the limb during gait. The data of 29 subjects (38 legs) with cerebral palsy (CP) were reviewed. Passive examination data were correlated with hip rotations during the whole gait cycle, and in stance only. Hip rotation in gait correlated significantly with passive external rotation (r=0.51-0.54), femoral anteversion (r=0.43-0.47), and passive internal rotation (r=0.36-0.41). The mid-point of passive hip rotation range correlated best with hip rotation in the stance phase of gait (r=0.57-0.58).

Kinematic and kinetic gait characteristics of normal children walking at a range of clinically relevant speeds

Kinematic and kinetic data were obtained from 36 normal children who walked at five different clinically relevant speeds, which were mostly slower than normal speed. Speed groups were normalized for body height. Speed significantly affected most of the stride parameters, joint angles, joint moments, and the ground reaction force in all three planes of motion. The effects of speed were not always the same over the whole range of speeds studied. The clinical relevance of these findings is that when comparing pathologic gait characteristics with those of normal children, these should be derived from the same walking speed. This may help to differentiate between effects caused by speed and underlying pathology.