Abstract

Background: In the presence of diabetic peripheral neuropathy, plantar ulceration occurs on high plantar pressure areas due to the repetitive, excessive mechanical loadings which causes tissue breakdown. Through this systematic review and meta-analysis, it is hoped that the underlying mechanism of what causes plantar ulceration is understood by looking into the effect of diabetic peripheral neuropathy (DPN) on gait patterns and plantar pressures. Research Question: What are the effects of diabetic neuropathy on lower limb kinetics, kinematics, muscle activity, spatiotemporal parameters and plantar pressure distributions in type 2 diabetes? Methods: A systematic literature search was done for studies evaluating the effect of DPN on joint kinetics and kinematics, electromyography, spatiotemporal parameters and plantar pressures during gait. Following a quality assessment of the sixteen studies, qualitative and meta-analysis was performed on these outcome measures. Results: The findings suggested that participants living with DPN exhibited reduced knee, ankle and rearfoot (Sha-Cal) kinematics, higher midfoot and rearfoot peak pressures and higher pressure-time integrals in the medial and lateral forefoot and midfoot regions. However, conflicting results were present in the spatiotemporal and electromyographic findings. Further research is required due to the paucity of information on this subject matter. Significance: Literature states that DPN may cause decreased knee and ankle joint movement, resulting in inadequate dorsiflexion during heel strike, thus redistributing plantar pressures to the midfoot and forefoot for longer periods, increasing the risk of ulceration. Further research, even in the presence of active ulceration, is required to understand better the underlying pathomechanics of DPN during gait.

Keywords

Diabetic peripheral neuropathy, plantar pressure, joint kinetics, joint kinematics, electromyography