Gait evaluation in children with type 1 diabetes

Abstract

Background: Diabetic foot problems are one of the most feared complications of diabetes (DM). Foot pathologies in children and adolescents who live with Type 1 DM (T1DM) are not uncommon and more so when these children become adults. However; there is a lack of studies investigating whether there are bio-mechanical alterations in the pediatric patients living with T1DM. It is also unknown whether T1DM affects the child’s foot structurally. Few studies have investigated bio-mechanical foot abnormalities in the diabetic child through motion capture analysis. Gait analysis provides an objective and quantitative evaluation, which improves the understanding of causes of gait abnormalities and guides treatment. Aims & Objectives: The main aim of this study was to determine if children aged between 10-16 years with insulin-dependent diabetes have altered foot type pathology and altered gait parameters when compared with children aged 10-16 years who do not live with any medical conditions. The objectives were to analyze any possible differences in foot type and foot deformities through a clinical biomechanical examination in children aged between 10-16 years old who live with and without Type 1 Diabetes Mellitus and to analyze gait via motion capture technology in these same children. Design and Methods: This quantitative research study employed a non-experimental, prospective comparative study. Thirty-four (ɳ=34) participants were recruited and divided into Group A, healthy children (ɳ=16) and Group B (ɳ=18), T1DM children, with children in both groups between the ages of 10-16 years. All participants underwent a thorough dermatological and biomechanical examinations. This was followed by motion capture gait analysis using the Oxford Foot Model in order to investigate foot segment motion. Results: T1DM children demonstrated more dermatological lesions such as hyperkeratotic lesions (33.3%) and in-growing toenails (22%) and structural foot abnormalities such as claw toes (33.3%) and hammer toes (22.2%) and hallux abducto valgus (11.1%) when compared to their healthy counterparts. 72.2% of T1DM children live with a pronated foot type as compared to 50% in heathy children. The results from the gait analysis utilizing the Oxford Foot Model indicate that there is a significant difference between healthy children and T1DMchildren at the hindfoot to tibia angle i.e. ankle dorsiflexion/plantarflexion at heel strike and toe-off, suggesting limited ankle joint motion. Conclusion: From the data obtained indicates that T1DM children have a higher incidence of structural foot pathology than non-diabetic children possibly associated with limited sagittal plane movement at the ankle joint. Thus; they have a need for regular podiatric care to assess, examine, diagnose and possibly manage these possible pathologies at an early stage in order to attempt to reduce their risk of more significant foot problems with DM when they reach their adult life.