Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis

Animesh Hazari, Arun G Maiya, K N Shivashankara, Ioannis Agouris, Ashma Monteiro, Radhika Jadhav, Sampath Kumar, C G Shashi Kumar, Shreemathi S Mayya, Animesh Hazari, Arun G Maiya, K N Shivashankara, Ioannis Agouris, Ashma Monteiro, Radhika Jadhav, Sampath Kumar, C G Shashi Kumar, Shreemathi S Mayya

Abstract

Background: Diabetes mellitus patients are at increased risk of developing diabetic foot with peripheral neuropathy, vascular and musculoskeletal complications. Therefore they are prone to develop frequent and often foot problems with a relative high risk of infection, gangrene and amputation. In addition, altered plantar pressure distribution is an important etiopathogenic risk factor for the development of foot ulcers. Thus the review on study of foot kinematic and kinetic in type 2 diabetes mellitus to understand the biomechanical changes is important.

Methodology: Scientific articles were obtained using electronic databases including Science Direct, CINAHL, Springer Link, Medline, Web of Science, and Pubmed. The selection was completed after reading the full texts. Studies using experimental design with focus on biomechanics of diabetic foot were selected.

Results: The meta-analysis report on gait velocity (neuropathy = 128 and non-diabetes = 131) showed that there was a significantly lower gait velocity in neuropathy participants compared to non-diabetes age matched participants at a high effect level (-0.09, 95 % CI -0.13 to 0.05; p < 0.0001). Regarding knee joint flexion range there was a significant difference between neuropathy and non-diabetes group (4.75, 95 % CI, -7.53 to 1.97, p = 0.0008).

Conclusions: The systematic review with meta-analysis reported significant difference in kinematic and kinetic variables among diabetic with neuropathy, diabetic without neuropathy and non-diabetes individuals. The review also found that the sample size in some studies were not statistically significant to perform the meta-analysis and report a strong conclusion. Therefore a study with higher sample size should be done.

Figures

Fig. 1
Fig. 1
Outlines the process and step wise results from an extensive literature search
Fig. 2
Fig. 2
Meta-analysis showing gait velocity in non-diabetes (control) compared to diabetes with neuropathy (negative mean difference represents higher mean values in the second group i.e. non-diabetes)
Fig. 3
Fig. 3
Meta-analysis showing gait velocity in non-diabetes compared to diabetes without neuropathy (negative mean difference represents higher mean values in the second group i.e. non-diabetes)
Fig. 4
Fig. 4
Meta-analysis showing stride length in non-diabetes compared to diabetes with neuropathy (negative mean difference represents higher mean values in the second group i.e. non-diabetes)
Fig. 5
Fig. 5
Meta-analysis showing stance period in diabetes with neuropathy compared to non-diabetes (positive mean difference represents higher mean values in first group i.e. diabetics with neuropathy)
Fig. 6
Fig. 6
Meta-analysis showing stride length in non-diabetes compared to diabetes without neuropathy (negative mean difference represents higher mean values in the second group i.e. non-diabetes)
Fig. 7
Fig. 7
Meta-analysis showing stride length in diabetes without neuropathy compared to diabetes with neuropathy (negative mean difference represents higher mean values in the second group i.e. Diabetes without neuropathy)
Fig. 8
Fig. 8
Meta-analysis report for hip flexion range between neuropathy and non-diabetes participants (results do not favor either group)
Fig. 9
Fig. 9
a Meta-analysis report for hip flexion range between non-neuropathy and non-diabetes participants (results do not favor either group). b Meta-analysis report for hip flexion range between non-neuropathy and neuropathy (negative mean difference represents higher mean values in the second group i.e. diabetes without neuropathy)
Fig. 10
Fig. 10
a Meta-analysis report for knee flexion range between neuropathy and non-diabetic participants (negative mean difference represents higher mean values in the second group i.e. non-diabetes). b Meta-analysis report for knee flexion range between neuropathy and non-neuropathy (results do not favor either group)
Fig. 11
Fig. 11
a Meta-analysis report for ankle dorsiflexion range between neuropathy and non-diabetic participants (negative mean difference represents higher mean values in the second group i.e. non-diabetes). b Meta-analysis report for ankle dorsiflexion range between neuropathy and non-neuropathy (results do not favor either group)
Fig. 12
Fig. 12
Meta-analysis report for plantar pressure between neuropathy and non-neuropathy (positive mean difference represents higher values in first group i.e. diabetes with neuropathy)
Fig. 13
Fig. 13
a Meta-analysis report for hind foot pressure between neuropathy and non-diabetic participants (results do not favor either group). b Meta-analysis report for fore foot pressure between neuropathy and non-diabetic participants (positive mean difference represents higher values in first group i.e. diabetes with neuropathy)
Fig. 14
Fig. 14
a Meta-analysis report for hind foot pressure between non-neuropathy and non-diabetic participants (results do not favor either group). b Meta-analysis report for fore foot pressure between non-neuropathy and non-diabetic participant (results do not favor either group). c Meta-analysis report for fore foot pressure between neuropathy and non-neuropathy (positive mean difference represents higher values in first group i.e. diabetes with neuropathy)
Fig. 15
Fig. 15
a Meta-analysis report for vertical ground reaction force at initial contact between neuropathy and non-neuropathy (results do not favor either group). b Meta-analysis report for vertical ground reaction force at toe off between neuropathy and non-neuropathy (results do not favor either group)
Fig. 16
Fig. 16
a Meta-analysis report for vertical ground reaction force at initial contact between neuropathy and non-diabetics (results do not favor either group). b Meta-analysis report for vertical ground reaction force at initial toe off between neuropathy and non-diabetics (results do not favor either group)
Fig. 17
Fig. 17
Meta-analysis report for peak plantar flexor moment between neuropathy and non-diabetics (negative mean difference represents higher mean values in the second group i.e. non-diabetes)
Fig. 18
Fig. 18
Meta-analysis report for peak knee extension moment between neuropathy and non-diabetics (results do not favor either group)
Fig. 19
Fig. 19
Meta-analysis report for peak hip flexion moment between neuropathy and non-diabetics (results do not favor either group)

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