The Impact of Diabetic Foot Ulcers and Unilateral Offloading Footwear on Gait in People With Diabetes

Authors

Erica Ling
Brian Lepow
He Zhou
Ana Enriquez
Ashley Mullen
Bijan Najafi

Publication Date

3-1-2020

Journal

Clinical Biomechanics

DOI

10.1016/j.clinbiomech.2020.01.014

PMID

31986461

PMCID

PMC7183883

PubMedCentral® Posted Date

3-1-2021

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Biomechanical Phenomena, Diabetic Foot, Female, Gait, Humans, Male, Middle Aged, Pressure, Quality of Life, Shoes, Weight-Bearing, diabetic foot ulcers, offloading, diabetic peripheral neuropathy, gait function, limp, gait unsteadiness

Abstract

BACKGROUND: Unilateral offloading footwear prescribed to patients with diabetic foot ulcers elevates one limb relative to the other, which may lead to limp and abnormal gait. This study investigated whether the unilateral foot ulcer and offloading combination negatively impacts gait function beyond diabetic peripheral neuropathy.

METHODS: Eighty-six participants were recruited in 3 groups: 12 with diabetic peripheral neuropathy and unilateral foot ulcers wearing offloading footwear (offloading group, age = 55.6 ± 9.5 years, BMI = 30.9 ± 4.5 kg/m

FINDINGS: The offloading group exhibited deteriorated gait function compared to the non-diabetic group (p < 0.005, Cohen's effect size d = 0.90-2.61). They also had decreased gait speed (p < 0.001, d = 1.79) and stride length (p < 0.001, d = 1.76), as well as increased gait cycle time (p < 0.001, d = 1.67) and limp (p < 0.050, d = 0.72-1.49) compared to the neuropathy group. The offloading group showed increased gait unsteadiness compared to the neuropathy group, but the difference did not reach statistical significance in our samples.

INTERPRETATION: This study demonstrated that while diabetic peripheral neuropathy deteriorates gait function, including increasing gait unsteadiness and limp, the diabetic foot ulcer and offloading combination magnifies the deterioration beyond diabetic peripheral neuropathy. These findings promote caution of the current standards of care for treating diabetic foot ulcers with offloading footwear. However, it is possible that a contralateral shoe lift may remedy deteriorated gait function and improve quality of life for unilateral offloading users.