DIFFERENCES IN THE GAIT CHARACTERISTICS OF PEOPLE WITH DIABETES AND TRANSMETATARSAL AMPUTATION COMPARED WITH AGE-MATCHED CONTROLS

Although qualitative reports in the surgical literature suggest that p eople with diabetes mellitus (DM) and transmetatarsal amputation (TMA) walk well with regular shoes and a toe-filler, recent data indicates that this population has multiple complications and difficulty with fu nctional mobility. A thorough description of their gait characteristic s may provide insights to the cause of these difficulties. The purpose of this study was to compare selected gait characteristics of people with DM and TMA to age-matched controls. We studied 15 subjects with D M and a TMA, and 15 age-matched controls with an overall mean age of 6 2.3 +/- 9.2 years. Data were collected with computer assisted video as subjects walked across a force platform. Range-of-motion (ROM), momen ts, and power were estimated at the ankle, knee, and hip in the sagitt al plane using standard link-segment methods. People with DM and TMA h ad decreased ROM excursion, peak moments, and peak power at the ankle. At the hip, people with DM and a TMA had decreased ROM excursion, an earlier onset of the hip flexor moment, but no differences in peak mom ents or peak power. Since people with DM and TMA have reduced ability to generate plantar flexor power at the ankle, they appear to rely mor e heavily on 'pulling' their leg forward from the hip using their hip flexor muscles. This compensation is not complete, however, as people with DM and a TMA take shorter steps and walk slower than controls. Ad ditional research is needed to determine methods to improve or better compensate for these gait deviations during late stance phase. (C) 199 8 Published by Elsevier Science B.V. All rights reserved.