Different foot kinematics, kinetics and plantar pressure patterns within the gait of diabetic subjects: cluster analysis
Abstract: The fundamental cause of lower-extremity complications in diabetes is chronic hyperglycemia leading to diabetic foot ulcer pathology. While the relationship between abnormal plantar pressure distribution and plantar ulcers has been widely investigated, little is known about the role of shear stress. Moreover, the mutual relationship between plantar pressure, shear stress, and abnormal kinematics in the etiology of diabetic foot has not been established. This study aims to develop a method for the simultaneous assessment of kinematics, kinetics and plantar pressure on foot subareas of diabetic subjects by means of combining 3 commercial systems. Another aim is to identify which parameters best describe the gait patterns using 3D gait data. Data were collected during gait on 35 patients (14 controls, 9 diabetics and 12 diabetic neuropathics) with a motion-capture system synchronized with two force plates and two baropodometric systems. A 4 segments 3D foot kinematics model was adopted for the subsegments angles estimation together with a three segment model for the plantar sub-area definition during gait. K-means cluster analysis was used to classify the samples into 2 or 3 clusters. The neuropathic group exhibited significantly excessive plantar pressure, ground reaction forces on each direction and a reduced loading surface on the midfoot subsegment. Furthermore the same subsegment displayed excessive dorsiflexion, external rotation and eversion. The cluster analysis showed the presence of more than one gait pattern for each biomechanics variable within the group of pathologic subjects. This methodology may enable a more appropriate characterization of patients at risk of foot ulcerations.
Listed In: Biomechanical Engineering, Gait,
Tagged In: cluster analysis., Diabetes neuropathy, diabetic foot, integrated, kinematics, kinetics, multisegments, plantar pressure, three dimensional
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