I.C.N. Sacco, A.N. Hamamoto, A.A. Gomes, A.N. Onodera, R.P. Hirata, E.M. Hennig

Received 27 October 2008. Accepted 7 May 2009

Background: The purpose of this study was to investigate the ankle range of motion during neuropathic gait and its influence on plantar pressure distribution in two phases during stance: at heel–strike and at push-off.

Methods: Thirty-one adults participated in this study (control group, n = 16; diabetic neuropathic group, n = 15). Dynamic ankle range of motion (electrogoniometer) and plantar pressures (PEDAR-X system) were acquired synchronously during walking. Plantar pressures were evaluated at rearfoot, midfoot and forefoot during the two phases of stance. General linear model repeated measures analysis of variance was applied to investigate relationships between groups, areas and stance phases.

Findings: Diabetic neuropathy patients walked using a smaller ankle range of motion in stance phase and smaller ankle flexion at heel–strike (P = 0.0005). Peak pressure and pressure–time integral values were higher in the diabetic group in the midfoot at push-off phase when compared to heel–strike phase. On the other hand, the control group showed similar values of peak pressure in midfoot during both stance phases.

Interpretation: The ankle mobility reduction observed could be associated to altered plantar pressure distribution observed in neuropathic subjects. Results demonstrated that midfoot and forefoot play a different role in subjects with neuropathy by receiving higher loads at push-off phase that are probably due to smaller ankle flexion at stance phase. This may explain the higher loads in anterior areas of the foot observed in diabetic neuropathy subjects and confirm an inadequate foot rollover associated to the smaller ankle range of motion at the heel–strike phase.

2009 Elsevier Ltd. All rights reserved.

Lancet 2005; 366: 1711–17 / www.thelancet.com Vol 366 November 12, 2005