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Magris R, Uchytil J, Cipryan L, Skýpala J, Jandacka D, Monte A. Elevated glycated haemoglobin affects Achilles tendon properties and walking capacity in healthy people without a diagnosis of diabetes. Sci Rep 2025; 15:16077. [PMID: 40341657 PMCID: PMC12062501 DOI: 10.1038/s41598-025-01219-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 05/05/2025] [Indexed: 05/10/2025] Open
Abstract
The aim of this study was to test the hypothesis that individuals with an increase in HbA1c (i.e. above the regular but below the diabetic threshold) exhibit an impairment in the Achilles tendon structure and walking capacity, due to the adverse effect of the advanced glycation end-product. One hundred fifty-eight participants matched for gender, age, physical activity and BMI, were divided in two cohorts based on the HbA1c level: normal HbA1c (NGH; <39 mmol/molHb; n = 79) and altered HbA1c (AGH; >=39 mmol/molHb; n = 79). Each participant performed several walking trials to evaluate the kinematic parameters during walling at the self-selected speed and a quantitative MRI scan of the Achilles tendon (AT) to obtain its intrinsic characteristics (i.e. T2* relaxation time short and long component). The AT T2* relaxation time short component (a parameter related to the tendon collagen quality) was reduced in AGH compared to NGH. Furthermore, AGH exhibited a slower self-selected walking speed (NGH: 1.59 ± 0.18 m/s; AGH:1.54 ± 0.16 m/s) and a shorter stride length (NGH: 1.59 ± 0.13 m; AGH:1.55 ± 0.11 m). Our data suggest that a non-pathological increase in HbA1c is able to negatively affect AT collagen quality and walking capacity in healthy people. These results highlight the importance of glycemic control, even below the pathological threshold. Since diabetes could alter several biological pathways, further studies are necessary to determine which mechanisms and their timing, regarding the HbA1c rise, affect tendon composition and, consequently, walking capacity.
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Affiliation(s)
- Riccardo Magris
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200, Ostrava, Czech Republic.
| | - Jaroslav Uchytil
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200, Ostrava, Czech Republic
| | - Lukáš Cipryan
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200, Ostrava, Czech Republic
| | - Jiří Skýpala
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200, Ostrava, Czech Republic
| | - Daniel Jandacka
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200, Ostrava, Czech Republic
| | - Andrea Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Magris R, Monte A, Nardello F, Trinchi M, Vigolo N, Negri C, Moghetti P, Zamparo P. Effects of minute oscillation stretching training on muscle and tendon stiffness and walking capability in people with type 2 diabetes. Eur J Appl Physiol 2025; 125:183-195. [PMID: 39249539 PMCID: PMC11746953 DOI: 10.1007/s00421-024-05596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/21/2024] [Indexed: 09/10/2024]
Abstract
AIM we investigated the effects of a 10 week training program (i.e., minute oscillatory stretching; MOS) on the mechanical responses and walking capability in people with type 2 diabetes (T2D). METHODS seventeen T2D patients performed maximum voluntary contractions of the plantar flexor muscles during which Achilles tendon stiffness (kT) and muscle-tendon stiffness (kM) were evaluated at different percentages of the maximum voluntary force (MVC). In addition, each participant was requested to walk at different walking speeds (i.e. 2, 3, 4, 5, and 6 kmh-1) while their net energy cost of walking (Cnet), cumulative EMG activity per distance travelled (CMAPD) and kinematic parameters (step length, step frequency, the ankle/knee range of motion) were evaluated. RESULTS maximum tendon elongation increased after MOS training, and kT significantly decreased (between 0 and 20% of MVC). No differences were observed for muscle elongation or kM after training. Cnet decreased after training (at the slowest tested speeds) while no changes in CMAPD were observed. Step length and ankle ROM during walking increased after training at the slowest tested speeds, while step frequency decreased; no significant effects were observed for knee ROM. CONCLUSION these results indicate the effectiveness of 10 weeks of MOS training in reducing tendon stiffness and the energy cost during walking in people with T2D. This training protocol requires no specific instrumentation, can be easily performed at home, and has a high adherence (92 ± 9%). It could, thus, be useful to mitigate mechanical tendon deterioration and improve physical behaviour in this population.
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Affiliation(s)
- Riccardo Magris
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Nardello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Trinchi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicolò Vigolo
- Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Negri
- Integrated University Hospital of Verona - Endocrinology, Diabetology and Metabolic Diseases Unit, Verona, Italy
| | - Paolo Moghetti
- Department of Medicine, University of Verona, Verona, Italy
| | - Paola Zamparo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Luis I, Afschrift M, De Groote F, Gutierrez-Farewik EM. Insights into muscle metabolic energetics: Modelling muscle-tendon mechanics and metabolic rates during walking across speeds. PLoS Comput Biol 2024; 20:e1012411. [PMID: 39269982 PMCID: PMC11424009 DOI: 10.1371/journal.pcbi.1012411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 09/25/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024] Open
Abstract
The metabolic energy rate of individual muscles is impossible to measure without invasive procedures. Prior studies have produced models to predict metabolic rates based on experimental observations of isolated muscle contraction from various species. Such models can provide reliable predictions of metabolic rates in humans if muscle properties and control are accurately modeled. This study aimed to examine how muscle-tendon model individualization and metabolic energy models influenced estimation of muscle-tendon states and time-series metabolic rates, to evaluate the agreement with empirical data, and to provide predictions of the metabolic rate of muscle groups and gait phases across walking speeds. Three-dimensional musculoskeletal simulations with prescribed kinematics and dynamics were performed. An optimal control formulation was used to compute muscle-tendon states with four levels of individualization, ranging from a scaled generic model and muscle controls based on minimal activations, inclusion of calibrated muscle passive forces, personalization of Achilles and quadriceps tendon stiffnesses, to finally informing muscle controls with electromyography. We computed metabolic rates based on existing models. Simulations with calibrated passive forces and personalized tendon stiffness most accurately estimate muscle excitations and fiber lengths. Interestingly, the inclusion of electromyography did not improve our estimates. The whole-body average metabolic cost was better estimated with a subset of metabolic energy models. We estimated metabolic rate peaks near early stance, pre-swing, and initial swing at all walking speeds. Plantarflexors accounted for the highest cost among muscle groups at the preferred speed and were similar to the cost of hip adductors and abductors combined. Also, the swing phase accounted for slightly more than one-quarter of the total cost in a gait cycle, and its relative cost decreased with walking speed. Our prediction might inform the design of assistive devices and rehabilitation treatment. The code and experimental data are available online.
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Affiliation(s)
- Israel Luis
- KTH MoveAbility, Dept. Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Maarten Afschrift
- Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands
| | | | - Elena M. Gutierrez-Farewik
- KTH MoveAbility, Dept. Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Patel SH, Campbell NW, Emenim CE, Farino DO, Damen FW, Rispoli JV, Goergen CJ, Haus JM, Sabbaghi A, Carroll CC. Patellar tendon biomechanical and morphologic properties and their relationship to serum clinical variables in persons with prediabetes and type 2 diabetes. J Orthop Res 2024; 42:1653-1669. [PMID: 38400550 PMCID: PMC11222058 DOI: 10.1002/jor.25816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/08/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
Tendon biomechanical properties and fibril organization are altered in patients with diabetes compared to healthy individuals, yet few biomarkers have been associated with in vivo tendon properties. We investigated the relationships between in vivo imaging-based tendon properties, serum variables, and patient characteristics across healthy controls (n = 14, age: 45 ± 5 years, body mass index [BMI]: 24 ± 1, hemoglobin A1c [HbA1c]: 5.3 ± 0.1%), prediabetes (n = 14, age: 54 ± 5 years, BMI: 29 ± 2; HbA1c: 5.7 ± 0.1), and type 2 diabetes (n = 13, age: 55 ± 3 years, BMI: 33 ± 2, HbA1c: 6.7 ± 0.3). We used ultrasound speckle-tracking and measurements from magnetic resonance imaging (MRI) to estimate the patellar tendon in vivo tangent modulus. Analysis of plasma c-peptide, interleukin-1β (IL-1β), IL-6, IL-8, tumor necrosis factor-α (TNF-α), adiponectin, leptin, insulin-like growth factor 1 (IGF-1), and C-reactive protein (CRP) was completed. We built regression models incorporating statistically significant covariates and indicators for the clinically defined groups. We found that tendon cross-sectional area normalized to body weight (BWN CSA) and modulus were lower in patients with type 2 diabetes than in healthy controls (p < 0.05). Our regression analysis revealed that a model that included BMI, leptin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), age, and group explained ~70% of the variability in BWN CSA (R2 = 0.70, p < 0.001). For modulus, including the main effects LDL, groups, HbA1c, age, BMI, cholesterol, IGF-1, c-peptide, leptin, and IL-6, accounted for ~54% of the variability in modulus (R2 = 0.54, p < 0.05). While BWN CSA and modulus were lower in those with diabetes, group was a poor predicter of tendon properties when considering the selected covariates. These data highlight the multifactorial nature of tendon changes with diabetes and suggest that blood variables could be reliable predictors of tendon properties.
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Affiliation(s)
- Shivam H. Patel
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | | | - Chinonso E. Emenim
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Dominick O. Farino
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Frederick W. Damen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Joseph V. Rispoli
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Craig J. Goergen
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Jacob M. Haus
- School of Kinesiology, University of Michigan, Ann Arbor, MI
| | | | - Chad C. Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
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Barsotti E, Goodman B, Samuelson R, Carvour ML. A Scoping Review of Wearable Technologies for Use in Individuals With Intellectual Disabilities and Diabetic Peripheral Neuropathy. J Diabetes Sci Technol 2024:19322968241231279. [PMID: 38439547 PMCID: PMC11571371 DOI: 10.1177/19322968241231279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Individuals with intellectual disabilities (IDs) are at risk of diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN), which can lead to foot ulcers and lower-extremity amputations. However, cognitive differences and communication barriers may impede some methods for screening and prevention of DPN. Wearable and mobile technologies-such as smartphone apps and pressure-sensitive insoles-could help to offset these barriers, yet little is known about the effectiveness of these technologies among individuals with ID. METHODS We conducted a scoping review of the databases Embase, PubMed, and Web of Science using search terms for DM, DPN, ID, and technology to diagnose or monitor DPN. Finding a lack of research in this area, we broadened our search terms to include any literature on technology to diagnose or monitor DPN and then applied these findings within the context of ID. RESULTS We identified 88 articles; 43 of 88 (48.9%) articles were concerned with gait mechanics or foot pressures. No articles explicitly included individuals with ID as the target population, although three articles involved individuals with other cognitive impairments (two among patients with a history of stroke, one among patients with hemodialysis-related cognitive changes). CONCLUSIONS Individuals with ID are not represented in studies using technology to diagnose or monitor DPN. This is a concern given the risk of DM complications among patients with ID and the potential for added benefit of such technologies to reduce barriers to screening and prevention. More studies should investigate how wearable devices can be used among patients with ID.
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Affiliation(s)
- Ercole Barsotti
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Bailey Goodman
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Riley Samuelson
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, IA, USA
| | - Martha L. Carvour
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Hoveizavi R, Gao F, Ramirez VJ, Shuman BR, Joiner JC, Fisher SJ. Compromised neuromuscular function of walking in people with diabetes: a narrative review. Diabetes Res Clin Pract 2023:110802. [PMID: 37356728 DOI: 10.1016/j.diabres.2023.110802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/18/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
AIM This review summarizes recent studies that have investigated the neuromuscular dysfunction of walking in people with diabetes and its relationship to ulcer formation. METHODS A comprehensive electronic search in the database (Scopus, Web of Science, PsycINFO, ProQuest, and PubMed) was performed for articles pertaining to diabetes and gait biomechanics. RESULTS The Achilles tendon is thicker and stiffer in those with diabetes. People with diabetes demonstrate changes in walking kinematics and kinetics, including slower self-selected gait speed, shorter stride length, longer stance phase duration, and decreased ankle, knee, and metatarsophalangeal (MTP) joint range of motion. EMG is altered during walking and may reflect diabetes-induced changes in muscle synergies. Synergies are notable because they provide a more holistic pattern of muscle activations and can help develop better tools for characterizing disease progression. CONCLUSION Diabetes compromises neuromuscular coordination and function. The mechanisms contributing to ulcer formation are incompletely understood. Diabetes-related gait impairments may be a significant independent risk factor for the development of foot ulcers.
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Affiliation(s)
- Roya Hoveizavi
- Department of Kinesiology and Health promotions, University of Kentucky, Lexington, KY, USA.
| | - Fan Gao
- Department of Kinesiology and Health promotions, University of Kentucky, Lexington, KY, USA.
| | - Vanessa J Ramirez
- US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Benjamin R Shuman
- RR&D Center for Limb Loss and MoBility (CLiMB), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Joshua C Joiner
- College of Medicine, University of Kentucky, Lexington, KY, USA.
| | - Simon J Fisher
- Division of Endocrinology, Diabetes and Metabolism, Dept. of Internal Medicine, University of Kentucky, Lexington, KY, USA.
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Patel SH, Carroll CC. Impact of elevated serum advanced glycation end products and exercise on intact and injured murine tendons. Connect Tissue Res 2023; 64:161-174. [PMID: 36282002 PMCID: PMC9992287 DOI: 10.1080/03008207.2022.2135508] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/09/2022] [Indexed: 02/03/2023]
Abstract
OVERVIEW Delayed tendon healing is a significant clinical challenge for those with diabetes. We explored the role of advanced glycation end-products (AGEs), a protein modification present at elevated levels in serum of individuals with diabetes, on injured and intact tendons using a mouse model. Cell proliferation following tissue injury is a vital component of healing. Based on our previous work demonstrating that AGEs limit cell proliferation, we proposed that AGEs are responsible for the delayed healing process commonly observed in diabetic patients. Further, in pursuit of interventional strategies, we suggested that moderate treadmill exercise may support a healing environment in the presence of AGEs as exercise has been shown to stimulate cell proliferation in tendon tissue. MATERIALS AND METHODS Mice began receiving daily intraperitoneal injections of bovine serum albumin (BSA)-Control or AGE-BSA injections (200μg/ml) at 16-weeks of age. A tendon injury was created in the central third of both patellar tendons. Animals assigned to an exercise group began a moderate treadmill protocol one week following injury. The intact Achilles tendon and soleus muscle were also evaluated to assess the effect of BSA and AGE-BSA on un-injured muscle and tendon. RESULTS We demonstrate that our injection dosing and schedule lead to an increase in serum AGEs. Our findings imply that AGEs indeed modulate gene expression following a patellar tendon injury and have modest effects on gene expression in intact muscle and tendon. CONCLUSIONS While additional biomechanical analysis is warranted, these data suggest that elevated serum AGEs in persons with diabetes may impact tendon health.
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Affiliation(s)
- Shivam H. Patel
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Chad C. Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
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Zhao P, Ding C, Fu X, Zhang Y, Gu J, Hu J, Wang C, Yang M, Sheng Y, Zhang Y, Chen X, Mao P, Liu CF. Ultrasound exploration of muscle characteristic changes and diabetic peripheral neuropathy in diabetic patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1403-1411. [PMID: 36218110 DOI: 10.1002/jcu.23365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Using brightness mode ultrasound combined with shear wave elastography, this study aims to detect structural and functional changes of the medial head of gastrocnemius (MG) in type 2 diabetes mellitus (T2DM) patients with or without diabetic peripheral neuropathy (DPN). METHODS 149 T2DM patients (DPN group and non-DPN group) and 60 healthy volunteers (control group) were enrolled. We measured the absolute difference of fascicle length (FL), pennation angle (PA), and shear wave velocity (SWV) of both MG in neutral position and maximal ankle joint's plantar flexion and calculated ΔFL, ΔPA, and ΔSWV. These three parameters, along with muscle thickness (MT), were compared among the three groups. RESULTS In the DPN group, the MG's MT, ΔPA, and ΔSWV were significantly lower than in the non-DPN group (p < 0.01); these parameters achieved the highest scores in the control group (p < 0.01). The area under the receiver operating characteristic curve of the combination of ΔSWV and ΔFL was the largest for predicting inpatients with or without DPN. CONCLUSIONS Decreased muscle mass (MT) and muscle contractibility (ΔFL and ΔSWV) were detected in patients with T2DM, with or without DPN. ΔSWV and ΔFL of the MG showed high-diagnostic accuracy for DPN warning signs.
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Affiliation(s)
- Ping Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Changwei Ding
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinxu Fu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiarui Gu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Caishan Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Yang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yujing Sheng
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaofang Chen
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Pan Mao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun-Feng Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Shi QQ, Li PL, Yick KL, Jiao J, Liu QL. Influence of Contoured Insoles with Different Materials on Kinematics and Kinetics Changes in Diabetic Elderly during Gait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12502. [PMID: 36231798 PMCID: PMC9566611 DOI: 10.3390/ijerph191912502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Alterations in the lower limb kinematics and kinetics of diabetic patients have been reported in previous studies. Inappropriate choices of orthopedic insole materials, however, fail to prevent diabetic foot ulcers and modify abnormal gait. The aim of this study was to quantitatively compare the effects of contoured insoles with different materials on the kinematics of and kinetics changes in the diabetic elderly during gait. METHODS There were 21 diabetic patients who participated in this study. Three-dimensional (3D) experimental contoured insoles constructed of soft (i.e., Nora Lunalastik EVA and PORON® Medical 4708) and rigid (i.e., Nora Lunalight A fresh and Pe-Lite) materials with Langer Biomechanics longitudinal PPT® arch pads were adopted. An eight-camera motion capture system (VICON), two force plates, and an insole measurement system-Pedar® with 99 sensors-were utilized to obtain the kinematics and kinetics data. The plug-in lower body gait model landmarks were used for dynamic data acquisition during gait. The corresponding data from five gait cycles were selected and calculated. RESULTS The range of motions (ROMs) of the ankle joint (p = 0.001) and knee joint (p = 0.044) were significantly influenced when the contoured insoles were worn in comparison to the barefoot condition. The joint moments of the lower limbs with maximum ankle plantarflexion during the loading response and maximum knee and hip flexions were significantly influenced by the use of contoured insoles with different materials in the diabetic elderly. The peak plantar pressure (PPP) of the forefoot (p < 0.001), midfoot (p = 0.009), and rearfoot (p < 0.001) was significantly offloaded by the contoured insoles during the stance phase, whilst the PPP of the rearfoot (p < 0.001) was significantly offloaded during the swing phase. CONCLUSIONS The contoured insoles, especially those constructed with soft materials, significantly offloaded the PPP during gait-hence accommodating certain abnormal gait patterns more effectively compared to going barefoot.
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Affiliation(s)
- Qiu-Qiong Shi
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - Pui-Ling Li
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Kit-Lun Yick
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Jiao Jiao
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China
| | - Qi-Long Liu
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
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Tecchio P, Zamparo P, Nardello F, Monte A. Achilles tendon mechanical properties during walking and running are underestimated when its curvature is not accounted for. J Biomech 2022; 137:111095. [PMID: 35472710 DOI: 10.1016/j.jbiomech.2022.111095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/07/2022] [Accepted: 04/08/2022] [Indexed: 11/25/2022]
Abstract
Achilles tendon (AT) mechanical properties can be estimated using an inverse dynamic approach, taking into account the tendon internal moment arm (IMA) and its kinematic behavior. Although AT presents a curvilinear line of action, a straight-line function to estimate IMA and AT length is often utilized in the literature. In this study, we combined kinetic, kinematic and ultrasound data to understand the impact of two different approaches (straight-line vs. curvilinear) in determining AT mechanical properties in vivo (during walking and running at the self-selected speed). AT force and power were calculated based on data of AT IMA and AT length derived by both respective methods. All investigated parameters were significantly affected by the method utilized (paired t-test; p < 0.05): when using the curvilinear method IMA was about 5% lower and AT length about 1.2% higher, whereas peak and mean values of AT force and power were 5% higher when compared to the straight-line method (both in walking and running). Statistic-parametric mapping (SMP) analysis revealed significant differences in IMA during the early and the late stance phase of walking and during the late stance phase of running (p < 0.01); SPM revealed significant differences also in AT length during the entire stance phase in both locomotion modes (p < 0.01). These results confirm and extend previous findings to human locomotion: neglecting the AT curvature might be a source of error, resulting in underestimates not only of internal moment arm and tendon length, but also of tendon force and power.
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Affiliation(s)
- Paolo Tecchio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy; Human Movement Science, Faculty of Sports Science, Ruhr University Bochum, Bochum, Germany.
| | - Paola Zamparo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Francesca Nardello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Andrea Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
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Wang Z, Peng S, Zhang H, Sun H, Hu J. Gait Parameters and Peripheral Neuropathy in Patients With Diabetes: A Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:891356. [PMID: 35721708 PMCID: PMC9199374 DOI: 10.3389/fendo.2022.891356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate the relationship between diabetic peripheral neuropathy (DPN) and gait abnormality in diabetic patients. METHODS Related research concerning the gait of diabetic patients with and without DPN was collected and analyzed by searching PubMed, Embase, and Web of Science. Statistical analysis was performed by using RevMan 5.3 software. RESULTS Twenty-one studies were included in this meta-analysis, consisting of 499 diabetic neuropathy patients and 467 diabetes controls without neuropathy. Meta-analysis results showed lower gait velocity, shorter stride length, longer stride time, longer stance time, and higher maximum knee extension moment in the DPN group, compared with their counterparts. CONCLUSION Among diabetic patients, those complicated with DPN possess lower gait velocity, shorter stride length, longer stride time, longer stance time, and higher maximum knee extension moment.
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Affiliation(s)
- Zhenchao Wang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Si Peng
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Endocrinology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Honghong Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Sun
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Hong Sun, ; Ji Hu,
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Hong Sun, ; Ji Hu,
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12
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Squier K, Scott A, Hunt MA, Brunham LR, Wilson DR, Screen H, Waugh CM. The effects of cholesterol accumulation on Achilles tendon biomechanics: A cross-sectional study. PLoS One 2021; 16:e0257269. [PMID: 34529718 PMCID: PMC8445482 DOI: 10.1371/journal.pone.0257269] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Familial hypercholesterolemia, a common genetic metabolic disorder characterized by high cholesterol levels, is involved in the development of atherosclerosis and other preventable diseases. Familial hypercholesterolemia can also cause tendinous abnormalities, such as thickening and xanthoma (tendon lipid accumulation) in the Achilles, which may impede tendon biomechanics. The objective of this study was to investigate the effect of cholesterol accumulation on the biomechanical performance of Achilles tendons, in vivo. 16 participants (10 men, 6 women; 37±6 years) with familial hypercholesterolemia, diagnosed with tendon xanthoma, and 16 controls (10 men, 6 women; 36±7 years) underwent Achilles biomechanical assessment. Achilles biomechanical data was obtained during preferred pace, shod, walking by analysis of lower limb kinematics and kinetics utilizing 3D motion capture and an instrumented treadmill. Gastrocnemius medialis muscle-tendon junction displacement was imaged using ultrasonography. Achilles stiffness, hysteresis, strain and force were calculated from displacement-force data acquired during loading cycles, and tested for statistical differences using one-way ANOVA. Statistical parametric mapping was used to examine group differences in temporal data. Participants with familial hypercholesterolemia displayed lower Achilles stiffness compared to the control group (familial hypercholesterolemia group: 87±20 N/mm; controls: 111±18 N/mm; p = 0.001), which appeared to be linked to Achilles loading rate rather than an increased strain (FH: 5.27±1.2%; controls: 4.95±0.9%; p = 0.413). We found different Achilles loading patterns in the familial hypercholesterolemia group, which were traced to differences in the centre of pressure progression that affected ankle moment. This finding may indicate that individuals with familial hypercholesterolemia use different Achilles loading strategies. Participants with familial hypercholesterolemia also demonstrated significantly greater Achilles hysteresis than the control group (familial hypercholesterolemia: 57.5±7.3%; controls: 43.8±10%; p<0.001), suggesting that walking may require a greater metabolic cost. Our results indicate that cholesterol accumulation could contribute to reduced Achilles function, while potentially increasing the chance of injury.
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Affiliation(s)
- Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alexander Scott
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael A. Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Liam R. Brunham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R. Wilson
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hazel Screen
- School of Engineering & Materials Science, Queen Mary University of London, London, United Kingdom
| | - Charlie M. Waugh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Lalumiere M, Perrino S, Nadeau MJ, Larivière C, Lamontagne M, Desmeules F, H. Gagnon D. To What Extent Do Musculoskeletal Ultrasound Biomarkers Relate to Pain, Flexibility, Strength, and Function in Individuals With Chronic Symptomatic Achilles Tendinopathy? FRONTIERS IN REHABILITATION SCIENCES 2021; 2:726313. [PMID: 36188777 PMCID: PMC9397971 DOI: 10.3389/fresc.2021.726313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 12/12/2022]
Abstract
Introduction: Achilles tendinopathy (AT) is a chronic musculoskeletal pathology best evaluated by ultrasound imaging. This cross-sectional study aimed at better understanding the relationship between musculoskeletal ultrasound biomarkers (MUBs) of Achilles tendon and localized pain, ankle flexibility, ankle strength, and functional abilities. Method: Forty-one participants with unilateral midportion chronic AT had their tendon images analyzed bilaterally in the longitudinal and transverse planes. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and Lower Extremity Functional Scale (LEFS) assessed pain and function, respectively, during standing and walking-related activities. Ankle flexibility was evaluated by weight-bearing lunge tests, while ankle isometric peak strength was measured using an instrumented dynamometer. Achilles tendon ultrasonographic images were analyzed using geometric (thickness), composition (echogenicity), and texture (homogeneity) MUBs. Discriminative validity was evaluated using paired Student's t-tests to compare MUBs between symptomatic and asymptomatic sides. Predictive validity was evaluated by computing the Pearson product-moment correlations coefficient between MUBs and pain, ankle flexibility, ankle strength, and function. Results: Significant differences were found in MUBs between the symptomatic and asymptomatic sides, confirming the discriminative validity of the selected MUBs. On the symptomatic side, thickness was found 29.9% higher (p < 0.001), echogenicity 9.6% lower (p < 0.001), and homogeneity 3.8% higher (p = 0.001) when compared with the asymptomatic side. However, predictive validity was scarcely confirmed, as most of the correlation coefficients were found negligible for the associations investigated between MUBs with localized pain, ankle flexibility, strength, and function. Only 14 statistically significant low to moderate associations were found, with negative and positive correlations ranging between −0.31 and −0.55 and between 0.34 and 0.54, respectively. Discussion: Musculoskeletal ultrasound biomarkers have a clinical utility in visualizing in vivo tendon integrity and diagnosing AT. MUBs should be valued as part of a comprehensive neuro-musculoskeletal assessment as they complement pain, flexibility, strength, and function measures. Altogether, they may inform the development and monitoring of a personalized rehabilitation treatment plan.
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Affiliation(s)
- Mathieu Lalumiere
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Sarah Perrino
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Christian Larivière
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, QC, Canada
| | | | - François Desmeules
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, QC, Canada
| | - Dany H. Gagnon
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- *Correspondence: Dany H. Gagnon orcid.org/0000-0003-3464-4667
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Waugh CM, Scott A. Substantial Achilles adaptation following strength training has no impact on tendon function during walking. PLoS One 2021; 16:e0255221. [PMID: 34324575 PMCID: PMC8320898 DOI: 10.1371/journal.pone.0255221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
Tendons are responsive to mechanical loading and their properties are often the target of intervention programs. The tendon's mechanical properties, particularly stiffness, also govern its function, therefore changes to these properties could have substantial influence on energy-saving mechanisms during activities utilizing the stretch-shortening cycle. We investigated Achilles tendon (AT) function in vivo during walking with respect to a training intervention that elicited significant increases in AT stiffness. 14 men and women completed 12-weeks of isometric plantarflexor strength training that increased AT stiffness, measured during isometric MVC, by ~31%. Before and after the intervention, participants walked shod at their preferred velocity on a fully-instrumented treadmill. Movement kinematics, kinetics and displacement of the gastrocnemius medialis muscle-tendon junction were captured synchronously using 3D motion capture and ultrasound imaging, respectively. A MANOVA test was used to examine changes in AT force, stress, strain, stiffness, Young's modulus, hysteresis and strain energy, measured during walking, before and following strength training. All were non-significant for a main effect of time, therefore no follow-up statistical tests were conducted. Changes in joint kinematics, tendon strain, velocity, work and power and muscle activity during the stance phase were assessed with 1D statistical parametric mapping, all of which also demonstrated a lack of change in response to the intervention. This in vivo examination of tendon function in walking provides an important foundation for investigating the functional consequences of training adaptations. We found substantial increases in AT stiffness did not impact on tendon function during walking. AT stiffness measured during walking, however, was unchanged with training, which suggests that increases in stiffness may not be evident across the whole force-elongation relation, a finding which may help explain previously mixed intervention results and guide future investigations in the functional implications of tendon adaptation.
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Affiliation(s)
- C. M. Waugh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A. Scott
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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Why heel spurs are traction spurs after all. Sci Rep 2021; 11:13291. [PMID: 34168232 PMCID: PMC8225903 DOI: 10.1038/s41598-021-92664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/11/2021] [Indexed: 11/24/2022] Open
Abstract
It is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces. Previous histological investigations focused on either one of the two spur locations, thereby potentially overlooking common features that refer to a uniform developmental mechanism. In this study, 19 feet from 16 cadavers were X-ray scanned to preselect calcanei with either plantar or posterior spurs. Subsequently, seven plantar and posterior spurs were histologically assessed. Five spur-free Achilles tendon and three plantar fascia entheses served as controls. Plantar spurs were located either intra- or supra-fascial whereas all Achilles spurs were intra-fascial. Both spur types consistently presented a trabecular architecture without a particular pattern, fibrocartilage at the tendinous entheses and the orientation of the spur tips was in line with the course of the attached soft tissues. Spurs of both entities revealed tapered areas close to their bases with bulky tips. Achilles and plantar heel spurs seem to be non-pathological calcaneal exostoses, which are likely results of traction forces. Both spur types revealed commonalities such as their trabecular architecture or the tip direction in relation to the attached soft tissues. Morphologically, heel spurs seem poorly adapted to compressive loads.
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16
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Waterval NFJ, Veerkamp K, Geijtenbeek T, Harlaar J, Nollet F, Brehm MA, van der Krogt MM. Validation of forward simulations to predict the effects of bilateral plantarflexor weakness on gait. Gait Posture 2021; 87:33-42. [PMID: 33882437 DOI: 10.1016/j.gaitpost.2021.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bilateral plantarflexor muscle weakness is a common impairment in many neuromuscular diseases. However, the way in which severity of plantarflexor weakness affects gait in terms of walking energy cost and speed is not fully understood. Predictive simulations are an attractive alternative to human experiments as simulations allow systematic alterations in muscle weakness. However, simulations of pathological gait have not yet been validated against experimental data, limiting their applicability. RESEARCH QUESTION Our first aim was to validate a predictive simulation framework for walking with bilateral plantarflexor weakness by comparing predicted gait against experimental gait data of patients with bilateral plantarflexor weakness. Secondly, we aimed to evaluate how incremental levels of bilateral plantarflexor weakness affect gait. METHODS We used a planar musculoskeletal model with 9 degrees of freedom and 9 Hill-type muscle-tendon units per leg. A state-dependent reflex-based controller optimized for a function combining energy cost, muscle activation squared and head acceleration was used to simulate gait. For validation, strength of the plantarflexors was reduced by 80 % and simulated gait compared with experimental data of 16 subjects with bilateral plantarflexor weakness. Subsequently, strength of the plantarflexors was reduced stepwise to evaluate its effect on gait kinematics and kinetics, walking energy cost and speed. RESULTS Simulations with 80 % weakness matched well with experimental hip and ankle kinematics and kinetics (R > 0.64), but less for knee kinetics (R < 0.55). With incremental strength reduction, especially beyond a reduction of 60 %, the maximal ankle moment and power decreased. Walking energy cost and speed showed a strong quadratic relation (R2>0.82) with plantarflexor strength. SIGNIFICANCE Our simulation framework predicted most gait changes due to bilateral plantarflexor weakness, and indicates that pathological gait features emerge especially when bilateral plantarflexor weakness exceeds 60 %. Our framework may support future research into the effect of pathologies or assistive devices on gait.
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Affiliation(s)
- N F J Waterval
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - K Veerkamp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Gold Coast Centre for Orthopaedic Research, Engineering and Education (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, Australia
| | - T Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - J Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Orthopaedics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - F Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - M A Brehm
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - M M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
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Reeves ND, Orlando G, Brown SJ. Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050457. [PMID: 34066681 PMCID: PMC8150714 DOI: 10.3390/medicina57050457] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 12/25/2022]
Abstract
Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.
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18
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Tomlinson DJ, Erskine RM, Morse CI, Pappachan JM, Sanderson-Gillard E, Onambélé-Pearson GL. The combined effects of obesity and ageing on skeletal muscle function and tendon properties in vivo in men. Endocrine 2021; 72:411-422. [PMID: 33484409 PMCID: PMC8128745 DOI: 10.1007/s12020-020-02601-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/24/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE We investigated the combined impact of ageing and obesity on Achilles tendon (AT) properties in vivo in men, utilizing three classification methods of obesity. METHOD Forty healthy, untrained men were categorised by age (young (18-49 years); older (50-80 years)), body mass index (BMI; normal weight (≥18.5-<25); overweight (≥25-<30); obese (≥30)), body fat% (normal adipose (<28%); high adiposity (≥28%)) and fat mass index (FMI; normal (3-6); excess fat (>6-9); high fat (>9). Assessment of body composition used dual-energy X-ray absorptiometry, gastrocnemius medialis (GM)/AT properties used dynamometry and ultrasonography and endocrine profiling used multiplex luminometry. RESULTS Older men had lower total range of motion (ROM; -11%; P = 0.020), GM AT force (-29%; P < 0.001), stiffness (-18%; P = 0.041), Young's modulus (-22%; P = 0.011) and AT stress (-28%; P < 0.001). All three methods of classifying obesity revealed obesity to be associated with lower total ROM (P = 0.014-0.039). AT cross sectional area (CSA) was larger with higher BMI (P = 0.030). However, after controlling for age, higher BMI only tended to be associated with greater tendon stiffness (P = 0.074). Interestingly, both AT CSA and stiffness were positively correlated with body mass (r = 0.644 and r = 0.520) and BMI (r = 0.541 and r = 0.493) in the young but not older adults. Finally, negative relationships were observed between AT CSA and pro-inflammatory cytokines TNF-α, IL-6 and IL-1β. CONCLUSIONS This is the first study to provide evidence of positive adaptations in tendon stiffness and size in vivo resulting from increased mass and BMI in young but not older men, irrespective of obesity classification.
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Affiliation(s)
- David J Tomlinson
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK.
| | - Robert M Erskine
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Institute of Sport, Exercise & Health, University College London, London, UK
| | - Christopher I Morse
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Emmanuel Sanderson-Gillard
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Gladys L Onambélé-Pearson
- Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
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Singh A, Zwirner J, Templer F, Kieser D, Klima S, Hammer N. On the morphological relations of the Achilles tendon and plantar fascia via the calcaneus: a cadaveric study. Sci Rep 2021; 11:5986. [PMID: 33727610 PMCID: PMC7966405 DOI: 10.1038/s41598-021-85251-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/17/2021] [Indexed: 02/08/2023] Open
Abstract
Current treatments of plantar fasciitis are based on the premise that the Achilles tendon (AT) and plantar fascia (PF) are mechanically directly linked, which is an area of debate. The aim of this study was to assess the morphological relationship between the AT and PF. Nineteen cadaveric feet were x-ray imaged, serially sectioned and plastinated for digital image analyses. Measurements of the AT and PF thicknesses and cross-sectional areas (CSA) were performed at their calcaneal insertion. The fiber continuity was histologically assessed in representative subsamples. Strong correlations exist between the CSA of the AT and PF at calcaneal insertion and the CSA of PF's insertional length (r = 0.80), and between the CSAs of AT's and PF's insertional lengths. Further correlations were observed between AT and PF thicknesses (r = 0.62). This close morphological relationship could, however, not be confirmed through x-ray nor complete fiber continuity in histology. This study provides evidence for a morphometric relationship between the AT and PF, which suggests the presence of a functional relationship between these two structures following the biological key idea that the structure determines the function. The observed morphological correlations substantiate the existing mechanical link between the AT and PF via the posterior calcaneus and might explain why calf stretches are a successful treatment option for plantar heel pain.
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Affiliation(s)
- A Singh
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - J Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
- Institute of Legal Medicine, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - F Templer
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - D Kieser
- Department of Orthopedic Surgery and MSM, Christchurch Hospital, Christchurch, New Zealand
| | - S Klima
- Orthopaedicus, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
| | - N Hammer
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.
- Department of Clinical and Macroscopic Anatomy, Medical University of Graz, Harrachgasse 21, 8010, Graz, Austria.
- Fraunhofer Institute for Machine Tools and Forming Technology, Section of Medical Engineering, Dresden, Germany.
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Lu PP, Chen MH, Dai GC, Li YJ, Shi L, Rui YF. Understanding cellular and molecular mechanisms of pathogenesis of diabetic tendinopathy. World J Stem Cells 2020; 12:1255-1275. [PMID: 33312397 PMCID: PMC7705468 DOI: 10.4252/wjsc.v12.i11.1255] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
There is accumulating evidence of an increased incidence of tendon disorders in people with diabetes mellitus. Diabetic tendinopathy is an important cause of chronic pain, restricted activity, and even tendon rupture in individuals. Tenocytes and tendon stem/progenitor cells (TSPCs) are the dominant cellular components associated with tendon homeostasis, maintenance, remodeling, and repair. Some previous studies have shown alterations in tenocytes and TSPCs in high glucose or diabetic conditions that might cause structural and functional variations in diabetic tendons and even accelerate the development and progression of diabetic tendinopathy. In this review, the biomechanical properties and histopathological changes in diabetic tendons are described. Then, the cellular and molecular alterations in both tenocytes and TSPCs are summarized, and the underlying mechanisms involved are also analyzed. A better understanding of the underlying cellular and molecular pathogenesis of diabetic tendinopathy would provide new insight for the exploration and development of effective therapeutics.
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Affiliation(s)
- Pan-Pan Lu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Min-Hao Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ying-Juan Li
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China.
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The twisted structure of the fetal calcaneal tendon is already visible in the second trimester. Surg Radiol Anat 2020; 43:1075-1082. [PMID: 33237333 PMCID: PMC8273059 DOI: 10.1007/s00276-020-02618-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The progress in morphological science results from the greater possibilities of intra-pubic diagnosis and treatment of congenital disabilities, including the motor system. However, the structure and macroscopic development of the calcaneal tendon have not been investigated in detail. Studies on the adult calcaneal tendon showed that the calcaneal tendon is composed of twisted subtendons. This study aimed to investigate the internal structure of the fetal calcaneal tendon in the second trimester. MATERIALS AND METHODS Thirty-six fetuses fixed in 10% formaldehyde were dissected using the layer-by-layer method and a surgical microscope. RESULTS The twisted structure of the calcaneal tendon was revealed in all specimens. The posterior layer of the calcaneal tendon is formed by the subtendon from the medial head of the gastrocnemius muscle. In contrast, the anterior layer is formed by the subtendon from the lateral head of the gastrocnemius muscle. The subtendon from the soleus muscle constitutes the anteromedial outline of the calcaneal tendon. The lateral outline of the calcaneal tendon is formed by the subtendon originating from the medial head of the gastrocnemius muscle. In contrast, the medial outline is formed by the subtendon from the soleus muscle. In most of the examined limbs, the plantaris tendon attached to the tuber calcanei was not directly connected to the calcaneal tendon. CONCLUSIONS The twisted structure of the subtendons of the fetal calcaneal tendon is already visible in the second trimester and is similar to that seen in adults.
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Metz VR, Andrade RM, Machado-Lima A, Amadio AC, Serrão JC, Greve JMD, Alonso AC. INFLUENCE OF DIABETIC NEUROPATHY ON GAIT COMPLEXITY. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-869220202605219295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: Human gait is a complex movement dependent on multilevel neural control, which allows a consistent, regular and complex periodic pattern, properties that characterize it as a nonlinear system. Sensory and motor deficits, with diminished proprioceptive responses, may reduce the adaptive capacity of the system, as demonstrated in Parkinson's, Alzheimer's and Huntington's diseases. However, little is known about the effect of peripheral diabetic neuropathy on these responses. Objectives: To analyze the influence of peripheral diabetic neuropathy on entropy in different gait environments. Methods: Ten elderly patients, with and without a diagnosis of peripheral diabetic neuropathy, walked on a treadmill (initial speed of 3 km/h, with 0.5 km/h increments every 5 minutes up to the speed of 5 km/h) to record center of mass acceleration in the vertical, mediolateral and anteroposterior components throughout the test. The sample entropy of the three vectors was calculated for each test speed. Results: The vertical component did not show any statistically significant differences. The mediolateral component showed statistically significant difference for the factors group, speed, and interaction between factors (group and speed). The anteroposterior component showed statistically significant differences for the group factor, but not for speed and interaction between factors (group and speed). Effect sizes classified as large were found in all the comparisons. Conclusions: Peripheral diabetic neuropathy produced changes in the ability to adapt to changes in the environment during gait, probably due to changes in the complexity of the multilevel neural control system, which depends on motor and sensory feedback, known to be affected by peripheral diabetic neuropathy. Level of Evidence II; Diagnostic studies - Investigating a diagnostic test.
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Nardello F, Bombieri F, Monte A. Leverage mechanical alterations during walking at self-selected speed in patients with Parkinson's disease. Gait Posture 2020; 79:175-182. [PMID: 32422557 DOI: 10.1016/j.gaitpost.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 12/30/2019] [Accepted: 04/29/2020] [Indexed: 02/02/2023]
Abstract
Individuals with Parkinson's disease (PD) show poor walking performance compared to healthy adults. Leverage changes may provide insight into this walking abnormality, since they have important effects on both biomechanical and physiological variables. Hence, we investigated the differences in internal and external moment arms at the knee and ankle joints, as well as the effective mechanical advantage during walking at self-selected speed. Furthermore, the effects on walking of a simultaneous cognitive task were analysed. Kinetic (resultant ground reaction force and joint moments), kinematic (movement speed) and mechanical leverage (internal and external moment arms) parameters of 10 mild-to-moderate PD patients and 10 age-matched controls were measured in single and dual task condition. Finally, effective mechanical advantage was calculated as the ratio between internal and external moment arm for each joint. PD patients had a slower walking and showed larger and lower values of knee and ankle joint moments, respectively. No difference in force among groups was recorded. External moment arms were larger (in both joints) for PD, whereas slight changes were observed for internal moment arms. Consequently, effective mechanical advantage values seemed to be lower for PD. Surprisingly, leverage difference among groups was reduced during the dual task condition, resulting in a "more effective" walking strategy for PD. These findings suggest that during single task PD patients have several leverage disadvantages, which could affect the joint assessment. On the contrary, during dual task they reduced these mechanical negative effects by positively obtaining normal values of effective mechanical advantage.
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Affiliation(s)
- F Nardello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - F Bombieri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Nuckols RW, Dick TJM, Beck ON, Sawicki GS. Ultrasound imaging links soleus muscle neuromechanics and energetics during human walking with elastic ankle exoskeletons. Sci Rep 2020; 10:3604. [PMID: 32109239 PMCID: PMC7046782 DOI: 10.1038/s41598-020-60360-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/07/2020] [Indexed: 11/16/2022] Open
Abstract
Unpowered exoskeletons with springs in parallel to human plantar flexor muscle-tendons can reduce the metabolic cost of walking. We used ultrasound imaging to look 'under the skin' and measure how exoskeleton stiffness alters soleus muscle contractile dynamics and shapes the user's metabolic rate during walking. Eleven participants (4F, 7M; age: 27.7 ± 3.3 years) walked on a treadmill at 1.25 m s-1 and 0% grade with elastic ankle exoskeletons (rotational stiffness: 0-250 Nm rad-1) in one training and two testing days. Metabolic savings were maximized (4.2%) at a stiffness of 50 Nm rad-1. As exoskeleton stiffness increased, the soleus muscle operated at longer lengths and improved economy (force/activation) during early stance, but this benefit was offset by faster shortening velocity and poorer economy in late stance. Changes in soleus activation rate correlated with changes in users' metabolic rate (p = 0.038, R2 = 0.44), highlighting a crucial link between muscle neuromechanics and exoskeleton performance; perhaps informing future 'muscle-in-the loop' exoskeleton controllers designed to steer contractile dynamics toward more economical force production.
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Affiliation(s)
- R W Nuckols
- Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University, Raleigh, NC, 27607, USA.
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA.
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA.
| | - T J M Dick
- Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University, Raleigh, NC, 27607, USA
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - O N Beck
- George W. Woodruff School of Mechanical Engineering and School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - G S Sawicki
- Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University, Raleigh, NC, 27607, USA.
- George W. Woodruff School of Mechanical Engineering and School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
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RABBI MOHAMMADFAZLE, GHAZALI KAMARULHAWARI, ALTWIJRI OMAR, ALQAHTANI MAHDI, RAHMAN SAMMATIUR, ALI MDASRAF, SUNDARAJ KENNETH, TAHA ZAHARI, AHAMED NIZAMUDDIN. SIGNIFICANCE OF ELECTROMYOGRAPHY IN THE ASSESSMENT OF DIABETIC NEUROPATHY. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419300011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diabetic neuropathy is one of the physical complications of diabetes mellitus (DM) patients with a long history of diabetes. An electromyography (EMG)-based assessment may be very useful for the management of diabetic neuropathy. In the present study, we aimed to summarize all of the findings and recommendations obtained from previous studies that investigated the application of EMG to the assessment of diabetic neuropathy. An extensive search of the prominent electronic databases PubMed, Google Scholar and Scopus was performed to evaluate the following areas: (i) what are the muscles to be evaluated by EMG for neuropathy assessment, (ii) what type of EMG methodologies have been used and (iii) what recommendation can be made for neuropathy detection. The major findings are summarized as follows: (i) very few studies have analyzed the correlation of the EMG signals acquired from peripheral muscles affected in neuropathy with those obtained with non-neuropathic complications, such as ankle sprain; (ii) EMG has been applied for the detection of diabetic neuropathy more than diabetes treatment; and (iii) neuropathy detection using an EMG-based assessment were mainly performed for type 2 DM patients aged at least 50 years.
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Affiliation(s)
- MOHAMMAD FAZLE RABBI
- Faculty of Electrical and Electronics Engineering, Universiti Malaysia Pahang, Pahang, Malaysia
| | - KAMARUL HAWARI GHAZALI
- Faculty of Electrical and Electronics Engineering, Universiti Malaysia Pahang, Pahang, Malaysia
| | - OMAR ALTWIJRI
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - MAHDI ALQAHTANI
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - SAM MATIUR RAHMAN
- Department of Software Engineering, Daffodil International University, Dhaka, Bangladesh
| | - MD. ASRAF ALI
- Department of Software Engineering, Daffodil International University, Dhaka, Bangladesh
| | - KENNETH SUNDARAJ
- Faculty of Electronics and Computer Engineering, Universiti Teknikal Malaysia Melaka, Melaka, Malaysia
| | - ZAHARI TAHA
- Faculty of Manufacturing Engineering, Universiti Malaysia Pahang, Pahang, Malaysia
| | - NIZAM UDDIN AHAMED
- Faculty of Manufacturing Engineering, Universiti Malaysia Pahang, Pahang, Malaysia
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İyidir ÖT, Rahatlı FK, Bozkuş Y, Ramazanova L, Turnaoğlu H, Nar A, Tütüncü NB. Acoustic Radiation Force Impulse Elastography and Ultrasonographic Findings of Achilles Tendon in Patients With and Without Diabetic Peripheral Neuropathy: A Cross-Sectional Study. Exp Clin Endocrinol Diabetes 2019; 129:99-103. [PMID: 30786314 DOI: 10.1055/a-0840-3292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS We aimed to evaluate the elastographic features of Achilles tendon with Acoustic Radiation Force Impulse in patients with and without diabetic neuropathy. METHODS According to the presence of peripheral neuropathy, 45 patients with type 2 diabetes were divided into 2 subgroups. Those with peripheral neuropathy were defined as group I (22 patients) and those without peripheral neuropathy were defined as group II (23 patients). A total of thirty age-, gender-, and body mass index-matched healthy individuals were selected as controls. All participants underwent both ultrasonographic and Acoustic Radiation Force Impulse elastographic examination in order to evaluate Achilles Tendon thickness and stiffness. RESULTS Achilles tendon thicknesses were similar between groups (p=0.991). Achilles tendon thicknesses of both patient groups were significantly higher than the control group (group I vs control p=0.01; group II vs control p=0.006). Stiffness values of Achilles tendons were similar between the control group and group II (p=0.993). Shear Wave Velocity was significantly lower in group I than group IIand control group (p<0.001). CONCLUSION Diabetic patients with neuropathy have thicker and softer Achilles tendon while the elasticity of Achilles tendon in diabetic patients without neuropathy is similar to the healthy controls. Softening of the Achilles tendon may be an early sign of diabetic foot and reveal the patients with a risk of diabetic foot.
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Affiliation(s)
- Özlem Turhan İyidir
- Department of Endocrinology and Metabolism, Başkent University, Ankara, Turkey
| | | | - Yusuf Bozkuş
- Department of Endocrinology and Metabolism, Başkent University, Ankara, Turkey
| | - Lala Ramazanova
- Department of Endocrinology and Metabolism, Başkent University, Ankara, Turkey
| | - Hale Turnaoğlu
- Department of Radiology, Başkent University, Ankara, Turkey
| | - Aslı Nar
- Department of Endocrinology and Metabolism, Başkent University, Ankara, Turkey
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Petrovic M, Maganaris CN, Bowling FL, Boulton AJM, Reeves ND. Vertical displacement of the centre of mass during walking in people with diabetes and diabetic neuropathy does not explain their higher metabolic cost of walking. J Biomech 2019; 83:85-90. [PMID: 30473134 DOI: 10.1016/j.jbiomech.2018.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022]
Abstract
People with diabetes display biomechanical gait alterations compared to controls and have a higher metabolic cost of walking (CoW), but it remains unknown whether differences in the vertical displacement of the body centre of mass (CoM) may play a role in this higher CoW. The aim of this study was to investigate vertical CoM displacement (and step length as a potential underpinning factor) as an explanatory factor in the previously observed increased CoW with diabetes. Thirty-one non-diabetic controls (Ctrl); 22 diabetic patients without peripheral neuropathy (DM) and 14 patients with moderate/severe Diabetic Peripheral Neuropathy (DPN), underwent gait analysis using a motion analysis system and force plates while walking at a range of matched speeds between 0.6 and 1.6 m/s. Vertical displacement of the CoM was measured over the gait cycle, and was not different in either diabetes patients with or without diabetic peripheral neuropathy compared to controls across the range of matched walking speeds examined (at 1 m/s: Ctrl: 5.59 (SD: 1.6), DM: 5.41 (1.63), DPN: 4.91 (1.66) cm; p > 0.05). The DPN group displayed significantly shorter steps (at 1 m/s: Ctrl: 69, DM: 67, DPN: 64 cm; p > 0.05) and higher cadence (at 1 m/s: Ctrl: 117 (SD1.12), DM: 119 (1.08), DPN: 122 (1.25) steps per minute; p > 0.05) across all walking speeds compared to controls. The vertical CoM displacement is therefore unlikely to be a factor in itself that contributes towards the higher CoW observed recently in people with diabetic neuropathy. The higher CoW in patients with diabetes may not be explained by the CoM displacement, but rather may be more related to shorter step lengths, increased cadence and the associated increased internal work and higher muscle forces developed by walking with more flexed joints.
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Affiliation(s)
- M Petrovic
- Research Centre for Musculoskeletal Science & Sports Medicine, School of Healthcare Science, Faculty of Science & Engineering, Manchester Metropolitan University, UK
| | - C N Maganaris
- School of Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - F L Bowling
- Faculty of Medical & Human Sciences, University of Manchester, UK
| | - A J M Boulton
- Faculty of Medical & Human Sciences, University of Manchester, UK; Diabetes Research Institute, University of Miami, Miami, FL, USA
| | - N D Reeves
- Research Centre for Musculoskeletal Science & Sports Medicine, School of Healthcare Science, Faculty of Science & Engineering, Manchester Metropolitan University, UK.
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