3D biomechanical analysis of foot in diabetes with and without peripheral neuropathy-a pilot study

There has been a profound increase in the prevalence of diabetes mellitus especially among the Asian The biomechanical alteration in the foot structure and function are an important predictive risk factor for development of foot complications in type 2 diabetes mellitus. The routine biomechanical analysis using advanced motion analysis software in a clinical population like diabetes mellitus is still lacking in Indian settings. Therefore the aim of the study was to analyse and compare the biomechanical parameters of foot in diabetes mellitus with and without neuropathy and normal individuals of similar age group. The study was conducted in the biomechanical lab, diabetic foot clinic, Kasturba Hospital, Manipal, Karnataka, India. Sixty participants (n=20 DM type 2 with neuropathy, n=20 DM Type 2 without neuropathy and n=20 normal healthy) participated in the study. The kinematic analysis was done at knee and ankle joint using 3D SIMI REALITY MOTION SYSTEM GmbH, Germany, with two high speed Basler (1394a/b, GigE, 100fps@1Megapixel)cameras. For kinetics I step software, Aetrex, U.S.A and Wintrack dynamic Scan foot mat, Medicapteure software, France, U.S.A was used. Significant difference was seen in kinematic and kinetic variables like knee joint angle at toe off (p=0.002), knee velocity at static, heel strike, midstance and toe-off (p=0.000), knee acceleration at static, heel strike and midstance (p=0.001,0.002,0.006 respectively), ankle joint angle at midstance (p=0.006), ankle velocity at static, heel strike and midstance (p=0.022,0.001,0.002)ankle acceleration at static, heel strike, mistance and toe-off (p=0.013,0.002,0.000,0.000 respectively), gait cycle duration (p=0.000), max average plantar pressure (0.021) and max. great toe pressure (p=0.025). There biomechanical differences among the diabetes with and without neuropathy and normal healthy are high and therefore biomechanical analysis is an important tool and can be used for early screening and prediction of altered kinematic and kinetics in diabetes mellitus population in India.