Alterations in lower limb kinematics and moments in partial foot amputation versus diabetic neuropathy

Gait compensatory mechanisms associated with partial foot amputation (PFA) and peripheral neuropathy (PN) aren't well understood.

Current study aimed to assess deviations in the sagittal plane kinematics and moments of the lower limb joints in PFA due to PN versus PN alone.

Sagittal plane ROM and moment of the ankle, knee, and hip joints were measured for 53 participants assigned into two well-matched groups: (A) 25 subjects with healed unilateral PFA and (B) 28 subjects with PN peripheral neuropathy (PN). Gait analysis was conducted using a baropodometric system and STT 3DMA system.

MANOVA revealed that both groups had a similar pattern of sagittal ROM curves of lower limbs (p = 0.402). However, PFA group showed a reduction in ankle plantar flexion during the preswing (p = 0.005). Descriptive analysis of the moment curves revealed that both groups had similar compensatory patterns, specifically reduction in ankle plantar flexion moment and reversal of knee moment during late stance. However, PN group had higher values.

Individuals with either PFA due to PN or PN alone showed similar alterations in the sagittal plane kinematics and moments of the lower limb joints; they walked cautiously with excessive dorsiflexion throughout the stance phase, and the late stance phase was the most affected, while they compensated for the reduction in the ankle plantar moment by shifting the knee moment into extension moment. The results suggested that PN, not PFA, may be the primary cause of the gait alterations and PFA surgery only worsens the compensatory mechanisms.