Limited joint mobility in the hands and feet of adolescents with Type 1 diabetes mellitus

Aims Limited joint mobility (LJM) in the foot has not been assessed in adol escents with Type 1 diabetes mellitus (DM) but is associated with neuropath ic ulceration in adults. This study was designed to determine the presence of LJM in adolescents with Type 1 DM and its association with microvascular disease. Methods The hands, feet and hips were examined in 302 diabetic adolescents and 51 nondiabetic controls (aged 11.5-20 years). LJM was defined as less t han the fifth percent reference for controls. Results Reduced motion was found in 35% of diabetic adolescents at the subt alar (ST) joint, 18% at the first metatarsophalangeal (MTP) joint, 26% at t he fifth metacarpophalangeal (MCP) joint and 13% had limited passive extens ion of the interphalangeal (IP) joints of the hands. Limited passive IP joi nt extension of the hands was not present in the controls. Limited active I P joint extension, a positive 'prayer sign', occurred in 35% of diabetic ad olescents and 14% of controls. Diabetic adolescents showing LJM in any of t hese areas, except the prayer sign, were more likely to have retinopathy (o dds ratio 2.53, CI:1.53-4.18). Those with LJM in the foot were more likely to have albumin excretion rates >7.5 mu g/min (OR 2.06, CI:1.16-3.68). Conclusion LJM in the feet of adolescents with Type 1 DM is associated with microvascular disease and is a useful routine clinical measure.