Advertisement

An investigation of the foot ankle joint mobility, muscle strength, and foot structure in adolescent with type 1 diabetes

  • Ebru Kaya Mutlu
  • Banu Unver
  • Hanifegul Taskiran
  • Ilker Tolga Ozgen
Original Article

Abstract

Muscle strength and joint mobility were decreased with type 1 diabetes mellitus (T1DM). However, the literature is limited about foot muscle strength, joint mobility, and structure in adolescent aged 13–17 with T1DM. The purpose of this study was to compare foot structure, muscle strength, and joint mobility of adolescents aged between 13 and 17 with T1DM to those of healthy adolescents. Cross-sectional study design including adolescents with T1DM aged 13–17 years, and healthy adolescents was used in the study. The range of motion (ROM) was measured by using a digital goniometer, and muscle strength was evaluated by using handheld-dynamometry. Footprint was used for foot structure. Assessments were performed by using the digital images, and Clarke’s angle (CA), Staheli Arch index (SAI), and Chippaux-Smirak index (CSI) were calculated by using a scientific image-analysis program, ImageJ. Forty-one T1DM and 28 healthy adolescents were included with a mean age of 15.29 ± 1.55 and 15.04 ± 1.42, respectively. The T1DM group had significantly lower dorsiflexion, inversion and eversion ROM, and lower tibialis anterior and gastrocnemius muscle test (p < 0.05, for all) compared with the control group. Statistically, significant differences were found in the right SAI and CSI between groups (p < 0.05), whereas no difference was found in CA (p > 0.05). Adolescents with T1DM have lower ankle and foot joint mobility and muscle strength and altered foot structure compared to their healthy contemporaries. This indicates that early screening of muscle strength and foot structure are important to determine and avoid various risks such as foot deformities, gait deviations, and ulcer.

Keywords

Type 1 diabetes mellitus Footprint Adolescent Muscle strength 

Notes

Acknowledgments

We thank all the participants involved in the survey. The help of ……..Omer Inan from …….Bandirma Onyedi Eylul University for the English review of the manuscript is very much acknowledged.

Compliance with ethical standards

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

There is no financial support or other benefits from commercial sources for the work.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Lopez-Miranda J, Perez-Martinez P, Marin C, Fuentes F, Delgado J, Perez-Jimenez F. Dietary fat, genes and insulin sensitivity. J Mol Med (Berl). 2007;85(3):213–26.CrossRefGoogle Scholar
  2. 2.
    VanBuecken D, Lord S, Greenbaum CJ. Changing the course of disease in type 1 diabetes. In: De Groot LJ, Beck-Peccoz P, Chrousos G, Dungan K, Grossman A, Hershman JM, et al., editors. Endotext. South Dartmouth: MDText.com, Inc.; 2000.Google Scholar
  3. 3.
    Patterson C, Guariguata L, Dahlquist G, Soltesz G, Ogle G, Silink M. Diabetes in the young—a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract. 2014;103(2):161–75.CrossRefPubMedGoogle Scholar
  4. 4.
    Sheehan AM, While AE, Coyne I. The experiences and impact of transition from child to adult healthcare services for young people with Type 1 diabetes: a systematic review. Diabet Med. 2015;32(4):440–58.CrossRefPubMedGoogle Scholar
  5. 5.
    Amin N, Doupis J. Diabetic foot disease: from the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities. World J Diabetes. 2016;7(7):153–64.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Merashli M, Chowdhury TA, Jawad AS. Musculoskeletal manifestations of diabetes mellitus. QJM. 2015;108(11):853–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Andreassen CS, Jakobsen J, Ringgaard S, Ejskjaer N, Andersen H. Accelerated atrophy of lower leg and foot muscles—a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI). Diabetologia. 2009;52(6):1182–91.CrossRefPubMedGoogle Scholar
  8. 8.
    Andersen H, Nielsen S, Mogensen CE, Jakobsen J. Muscle strength in type 2 diabetes. Diabetes. 2004;53(6):1543–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Andersen H, Gadeberg PC, Brock B, Jakobsen J. Muscular atrophy in diabetic neuropathy: a stereological magnetic resonance imaging study. Diabetologia. 1997;40(9):1062–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Andersen H, Gjerstad MD, Jakobsen J. Atrophy of foot muscles: a measure of diabetic neuropathy. Diabetes Care. 2004;27(10):2382–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Boulton AJ. The pathogenesis of diabetic foot problems: an overview. Diabet Med. 1996;13(Suppl 1):S12–6.PubMedGoogle Scholar
  12. 12.
    Erol K, Karahan AY, Kerimoglu U, Ordahan B, Tekin L, Sahin M, et al. An important cause of pes planus: the posterior tibial tendon dysfunction. Clin Pract. 2015;5(1):699.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Allan J, Munro W, Figgins E. Foot deformities within the diabetic foot and their influence on biomechanics: a review of the literature. Prosthetics Orthot Int. 2016;40(2):182–92.CrossRefGoogle Scholar
  14. 14.
    Rosenbaum AJ, Lisella J, Patel N, Phillips N. The cavus foot. Med Clin North Am. 2014;98(2):301–12.CrossRefPubMedGoogle Scholar
  15. 15.
    Fernando M, Crowther R, Lazzarini P, Sangla K, Cunningham M, Buttner P, et al. Biomechanical characteristics of peripheral diabetic neuropathy: a systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure. Clin Biomech (Bristol, Avon). 2013;28(8):831–45.CrossRefGoogle Scholar
  16. 16.
    Toth C, Hebert V, Gougeon C, Virtanen H, Mah JK, Pacaud D. Motor unit number estimations are smaller in children with type 1 diabetes mellitus: a case-cohort study. Muscle Nerve. 2014;50(4):593–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Margeirsdottir HD, Larsen JR, Kummernes SJ, Brunborg C, Dahl-Jorgensen K. The establishment of a new national network leads to quality improvement in childhood diabetes: implementation of the ISPAD Guidelines. Pediatr Diabetes. 2010;11(2):88–95.CrossRefPubMedGoogle Scholar
  18. 18.
    Clarkson HM. Musculoskeletal assessment: joint range of motion and manual muscle strength: Lippincott Williams & Wilkins; 2000.Google Scholar
  19. 19.
    Hebert LJ, Maltais DB, Lepage C, Saulnier J, Crete M, Perron M. Isometric muscle strength in youth assessed by hand-held dynamometry: a feasibility, reliability, and validity study. Pediatr Phys Ther. 2011;23(3):289–99.CrossRefPubMedGoogle Scholar
  20. 20.
    Wever A, Schickenberg-Werrij BG, Willems J, Schaper NC, Schott DA. Prevalence and awareness of functional and structural foot abnormalities in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab. 2016; doi: 10.1515/jpem-2015-0455.PubMedGoogle Scholar
  21. 21.
    Stark T, Walker B, Phillips JK, Fejer R, Beck R. Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review. PM R. 2011;3(5):472–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Escolar DM, Henricson EK, Mayhew J, Florence J, Leshner R, Patel KM, et al. Clinical evaluator reliability for quantitative and manual muscle testing measures of strength in children. Muscle Nerve. 2001;24(6):787–93.CrossRefPubMedGoogle Scholar
  23. 23.
    Clarke HH. An objective method of measuring the height of the longitudinal arch in foot examinations. Research Quarterly American Physical Education Association. 1933;4(3):99–107.Google Scholar
  24. 24.
    Razeghi M, Batt ME. Foot type classification: a critical review of current methods. Gait & posture. 2002;15(3):282–91.CrossRefGoogle Scholar
  25. 25.
    Chen KC, Yeh CJ, Kuo JF, Hsieh CL, Yang SF, Wang CH. Footprint analysis of flatfoot in preschool-aged children. Eur J Pediatr. 2011;170(5):611–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Staheli LT, Chew DE, Corbett M. The longitudinal arch. A survey of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg Am. 1987;69(3):426–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Forriol F, Pascual J. Footprint analysis between three and seventeen years of age. Foot Ankle. 1990;11(2):101–4.CrossRefPubMedGoogle Scholar
  28. 28.
    Queen RM, Mall NA, Hardaker WM, Nunley II. JA. Describing the medial longitudinal arch using footprint indices and a clinical grading system. Foot & ankle international. 2007;28(4):456–62.CrossRefGoogle Scholar
  29. 29.
    Echarri JJ, Forriol F. The development in footprint morphology in 1851 Congolese children from urban and rural areas, and the relationship between this and wearing shoes. J Pediatr Orthop B. 2003;12(2):141–6.PubMedGoogle Scholar
  30. 30.
    Rosenbloom AL. Limited joint mobility in childhood diabetes: discovery, description, and decline. J Clin Endocrinol Metab. 2013;98(2):466–73.CrossRefPubMedGoogle Scholar
  31. 31.
    Francia P, Seghieri G, Gulisano M, De Bellis A, Toni S, Tedeschi A, et al. The role of joint mobility in evaluating and monitoring the risk of diabetic foot ulcer. Diabetes Res Clin Pract. 2015;108(3):398–404.CrossRefPubMedGoogle Scholar
  32. 32.
    Nagesh VS, Kalra S. Type 1 diabetes: syndromes in resource-challenged settings. J Pak Med Assoc. 2015;65(6):681–5.PubMedGoogle Scholar
  33. 33.
    Greenman RL, Khaodhiar L, Lima C, Dinh T, Giurini JM, Veves A. Foot small muscle atrophy is present before the detection of clinical neuropathy. Diabetes Care. 2005;28(6):1425–30.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Barnett SJ, Shield JP, Potter MJ, Baum JD. Foot pathology in insulin dependent diabetes. Arch Dis Child. 1995;73(2):151–3.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    van Schie CH, Vermigli C, Carrington AL, Boulton A. Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in caucasian diabetic men. Diabetes Care. 2004;27(7):1668–73.CrossRefPubMedGoogle Scholar
  36. 36.
    Cheuy VA, Hastings MK, Commean PK, Mueller MJ. Muscle and joint factors associated with forefoot deformity in the diabetic neuropathic foot. Foot & ankle international. 2015; doi: 10.1177/1071100715621544.Google Scholar
  37. 37.
    Kothari A, Bhuva S, Stebbins J, Zavatsky AB, Theologis T. An investigation into the aetiology of flexible flat feet: the role of subtalar joint morphology. Bone Joint J. 2016;98-b(4):564–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Aggarwal N, Garg C, Bawa H. Comparison of foot posture in runners (sprinters) and non runners in Indian population. The Physiotherapy Post. 6(1):268–71.Google Scholar
  39. 39.
    Riddiford-Harland DL, Steele JR, Storlien LH. Does obesity influence foot structure in prepubescent children? International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 2000;24(5):541–4.CrossRefGoogle Scholar
  40. 40.
    Pita-Fernandez S, Gonzalez-Martin C, Seoane-Pillado T, Lopez-Calvino B, Pertega-Diaz S, Gil-Guillen V. Validity of footprint analysis to determine flatfoot using clinical diagnosis as the gold standard in a random sample aged 40 years and older. Journal of epidemiology. 2015;25(2):148–54.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Villarroya MA, Esquivel JM, Tomas C, Moreno LA, Buenafe A, Bueno G. Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study. Eur J Pediatr. 2009;168(5):559–67.CrossRefPubMedGoogle Scholar
  42. 42.
    Francia P, Anichini R, De Bellis A, Seghieri G, Lazzeri R, Paternostro F, et al. Diabetic foot prevention: the role of exercise therapy in the treatment of limited joint mobility, muscle weakness and reduced gait speed. Ital J Anat Embryol. 2015;120(1):21–32.PubMedGoogle Scholar
  43. 43.
    Singla R, Gupta Y, Kalra S. Musculoskeletal effects of diabetes mellitus. J Pak Med Assoc. 2015;65(9):1024–7.PubMedGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2017

Authors and Affiliations

  • Ebru Kaya Mutlu
    • 1
  • Banu Unver
    • 2
  • Hanifegul Taskiran
    • 2
  • Ilker Tolga Ozgen
    • 3
  1. 1.Faculty of Health Sciences, Division of Physiotherapy and RehabilitationIstanbul UniversityBakırkoy/IstanbulTurkey
  2. 2.Faculty of Health Sciences, Division of Physiotherapy and RehabilitationIstanbul Aydin UniversityFlorya/IstanbulTurkey
  3. 3.Faculty of Medicine, Department of PaediatricsBezmialem UniversityFatih/IstanbulTurkey

Personalised recommendations