The role of joint mobility in evaluating and monitoring the risk of diabetic foot ulcer. Issue 3 (June 2015)

• Record Type: Journal Article
• Authors: Francia, Piergiorgio; Seghieri, Giuseppe; Gulisano, Massimo; De Bellis, Alessandra; Toni, Sonia; Tedeschi, Anna; Anichini, Roberto
• Is Part Of: Diabetes research and clinical practice. Volume 108:Issue 3(2015)
• Page Start: 398
• Page End: 404
• Publication Date: 2015-06
• Subjects: Diabetic foot -- Ankle range of motion -- Limited joint mobility -- Foot ulcer risk scale; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2015.04.001
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Ankle range of motion decreases as the risk of ulceration increases. Reduced ankle range of motion represents an early risk factor of foot ulceration. Diabetes seems to affect particularly ankle plantar flexion. Aging seems to affect particularly ankle dorsal flexion. Ankle joint mobility is a useful indicator for monitoring the risk of foot ulcer. Abstract: Aims: Evaluation of how ankle joint mobility (AJM) can be useful in the identification of patients with diabetes at risk of foot ulcer (FU). Methods: Plantar and dorsal flexion of foot were evaluated using an inclinometer in 87 patients (54 type 2 and 33 type 1), and 35 healthy sex- and age-matched control subjects. Patients with diabetes were followed up for diagnosis of FU over the next 8 years and subsequently, patients were subdivided into: those without a history of FU (18 type 1 and 33 type 2), those who had a history of FU detected before baseline evaluation (14 type 2) and those who had history of first ulceration detected by the 8th year of the evaluation period (7 type 2). Results: Aging and diabetes caused a significant reduction in mobility of each of the movements investigated ( p < 0.001), whereas after adjusting for the confounding effect of age, diabetes specifically reduced plantar flexion ( p < 0.0001). AJM was significantly lower in those with history of previous FU compared to all the other groups ( p < 0.001). The first ulceration was detected in the same foot presenting lower AJM in 17 of the 22 subjects with diabetes with history of ulcer (77.27%). Conclusions: Diabetes and aging reduce AJM although diabetes seems to reduce plantar flexion to a more specific extent. Reduced AJM is mostly associated with a previous history of FU. The evaluation of AJM is a valid and reliable ulcer risk scale that indicates which foot is at higher ulcer risk.