Functional outcome in people with diabetic neuropathy at four stages of foot complications
- Dr. Rajani Kanade
- Prof. Patricia Price (Wound Healing Research Unit, School of Medicine, Cardiff University)
- Prof. Keith Harding (Wound Healing Research Unit, School of Medicine, Cardiff University)
- Dr. Robert van Deursen
This study investigated the changes in functional outcome across four patient groups with diabetic neuropathy at consequent stages of foot complications namely: diabetic neuropathy without history of plantar ulceration (DMPN), active plantar ulceration (DFU), healed unilateral partial foot amputations (PFA) and healed unilateral trans-tibial amputations (TTA). Four matched groups of patients with DMPN were studied: DMPN: n=23; DFU: n=23; PFA: n=16 and TTA: n=22. Measures to evaluate function in 3 domains were used, namely Mobility and its impact on weight-bearing (sit-to-stand, standing balance, gait and plantar pressures during walking), Level of Activity (capacity and performance of walking) and Health-related Quality of Life (H-RQOL).
There was a significant difference in functional outcome between the four groups demonstrating an overall decline in the level of function with the progression of impairment (standing balance: p=0.002, gait velocity: p<0.001, daily strides: p<0.001, SF-36 Physical function: p<0.001). The risk of plantar injury to the entire affected foot during walking increased from DMPN to DFU to PFA (p=0.013).
The overall decline demonstrated in this study in the three domains of function with progression of physical impairment from the DMPN to TTA group, calls for an urgent need to define a tailor-made rehabilitation programme to maximise function of these patient groups. The increasing risk of plantar injury from DMPN to DFU to PFA during walking warrants a greater and precise focus on foot care of the affected as well as the contra-lateral foot.