Segmental lower limb mobility, muscle activity and plantar pressure analysis in individuals living with diabetic peripheral neuropathy : a systematic review and meta-analysis

Abstract

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, affecting up to 50% of individuals and their quality of life. DPN is characterised by the progressive loss of proprioception, somatosensory sensitivity and intrinsic distal muscle function. Musculoskeletal complications may cause bony deformities, such as clawing of digits and prominence of metatarsophalangeal joints and increase plantar pressures resulting in skin breakdown and ulceration. Since the repetitive action of mechanical stress during gait in the presence of DPN may lead to ulcer development, better understanding of the mechanism and biomechanical components of ulcer development is of vital importance. Literature shows that DFU are found on high plantar pressure areas, however, in the absence of neuropathy, high pressure areas alone do not lead to ulceration. This systematic review and meta-analysis aims to provide a comprehensive understanding of lower limb joint and muscle function and plantar pressures during gait in the presence of DPN. This, may provide evidence for the design of more efficient and specific treatment options of healing in order to prevent risk of amputation and reulceration. Reducing the mechanical loading on the ulcerated foot during gait may influence the healing of DFU and provide preventative mechanisms of ulceration.