Midfoot and ankle movement coordination during heel rise is disrupted in people with diabetes and peripheral neuropathy

Abstract

Background: A heel rise task can be used to evaluate midfoot and ankle movement dysfunction in people with diabetes mellitus and peripheral neuropathy. Quantifying movement coordination during heel rise is important to better understand potentially detrimental movement strategies in people with foot pathologies; however, coordination and the impact of limited excursion on coordination is not well-understood in people with diabetes.

Methods: Sixty patients with diabetes mellitus and peripheral neuropathy, and 22 older and 25 younger controls performed single-limb heel rise task. Midfoot (forefoot relative to hindfoot) sagittal and ankle (hindfoot relative to shank) sagittal and frontal kinematics were measured and normalized to time (0 to 100%). Cross-correlation coefficients were calculated across individuals in each group. A graphical illustration was used to interpret the relationship of midfoot and ankle excursion and cross-correlation coefficient during heel rise.

Findings: People with diabetes mellitus and peripheral neuropathy showed significantly lower midfoot and ankle cross-correlation coefficients during heel rise compared to older controls (p = 0.003-0.007). There was no difference in the midfoot and ankle cross-correlation coefficients during heel rise for the older and younger controls (p = 0.059-0.425). The graphic data illustrated a trend of greater excursion of two joints and a higher cross-correlation coefficient. Some individuals with lower excursion showed a high cross-correlation coefficient.

Interpretation: Foot pathologies, but not aging, impairs midfoot and ankle movement coordination during heel rise task. Investigating both movement coordination as well as joint excursion would better inform and characterize the dynamic movements of midfoot and ankle during heel rise task.

Keywords: Aging; Coupling; Foot; Heel rise; Peripheral neuropathy.

Figure 1.

Examples of normalized data for heel rise sagittal plane kinematics of the midfoot (blue) and ankle (orange): (A) very high CC in the expected direction, (B) poor CC in the expected direction, and (C) very high CC in an unexpected direction. Abbreviation: CC, cross-correlation coefficient.

Figure 2.

Scatter plot of individual data points that represent values for different joint excursions: (A) midfoot sagittal and ankle sagittal, (B) midfoot sagittal and ankle frontal, and (C) ankle sagittal and ankle frontal. Circles are the DMPN group, triangles are the OC group, and squares are the YC group. Individuals with expected excursion (i.e., midfoot and ankle sagittal in plantarflexion or ankle frontal in inversion) would be displayed in the upper right quadrant. The darker green color indicates higher CC. Individuals with one of the joints moving in opposite from expected direction (i.e., midfoot sagittal in dorsiflexion while ankle sagittal in plantarflexion or ankle frontal in inversion) would be displayed in the upper left quadrant. The darker orange indicates higher CC in opposite direction. Red circled points on the graphs are examples of individuals that have similar CC value with high or low excursions. Abbreviations: DMPN, diabetes mellitus and peripheral neuropathy; OC, older controls; YC, younger controls; CC, cross-correlation coefficient.

Figure 3.

Examples of midfoot sagittal (blue) – ankle sagittal (orange). (A) Individual with very high cross-correlation coefficient (CC = 0.97) and larger ankle excursion compared to (B) individual with very high cross-correlation coefficient (CC = 0.96) and lower ankle excursion during unilateral heel rise. Abbreviation: CC, cross-correlation coefficient.