The role of foot morphology on foot function in diabetic subjects with or without neuropathy

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P < 0.05), decreased contact surface on the hindfoot (P < 0.03).While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions.

► Simultaneous three-dimensional kinematics and pressure analysis of three foot's subsegments: hindfoot, midfoot, forefoot. ► Comparison between controls, diabetics non neuropathic and neuropathic subjects' foot biomechanics. ► Foot morphology contribution to altered biomechanics. ► Data were collected during gait on 60 subjects: 20 controls and 40 diabetics. ► Statistically significant alterations on neuropathic and diabetic subjects with different foot morphology and heel/hallux alignment.