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Aim The aim of this study was to examine foot function in the presence of diabetes-induced alterations of the anatomical and biomechanical unit formed by the Achilles tendon, plantar fascia and metatarso-phalangeal joints. More specifically, we focused on the Windlass mechanism, the physiological mechanism which entails stiffening of the foot during propulsion.
Methods Sixty-one diabetic patients, with or without neuropathy, and 21 healthy volunteers were recruited. The thickness of Achilles tendon and plantar fascia was measured by ultrasound. The main biomechanical parameters of foot–floor interaction during gait were acquired by means of dedicated platforms. The range of motion of the 1st metatarso-phalangeal joint was measured passively.
Results The plantar fascia (PF) and Achilles tendon (AT) were significantly thickened in diabetic patients [control subjects: PF 2.0 ± 0.5 mm, AT 4.0 ± 0.5 mm; diabetic patients without neuropathy: PF 2.9 ± 1.2 mm (P = 0.002), AT 4.6 ± 1.0 mm (P = 0.016); diabetic patients with neuropathy: PF 3.0 ± 0.8 mm (P < 0.0001), AT 4.9 ± 1.7 mm (P = 0.026)]. Joint mobility was significantly reduced [control subjects: 100.0 ± 10.0°; diabetic patients without neuropathy: 54.0 ± 29.4° (P < 0.0001); diabetic patients with neuropathy: 54.9 ± 17.2° (P < 0.0001)]. Loading times and force integrals under the heel and the metatarsals increased [metatarsal loading time (% stance phase): control subjects 88.2 ± 4.1%; diabetic patients without neuropathy 90.1 ± 4.7% (P = 0.146); diabetic patients with neuropathy 91.7 ± 6.6% (P = 0.048)].
Conclusions Increased thickness of Achilles tendon and plantar fascia, more evident in the presence of neuropathy, may contribute to an overall increase of tensile force and to the occurrence of an early Windlass mechanism, maintained throughout the whole gait cycle. This might play a significant role in the overall alteration of the biomechanics of the foot–ankle complex.
I fail to see how the data supports the conclusion (I have ordered but not yet read the full paper).
How does Increased thickness of Achilles tendon and plantar fascia, contribute to the occurrence of an early Windlass mechanism - from what I can read they measured tickness of the tissues and plantar loading times and forces --- they did not measure windlass timing!
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
The windlass in diabetes
Linear Mode
