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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Lower limb biomechanical characetristics of patients with neuropathic diabetic foot ulcers: The diabetes foot ulcer study protocol
Authors: Fernando, Malindu
Crowther, Robert
Cunningham, Margaret
Lazzarini, Peter
Sangla, Kunwarjit
Golledge, Jonathan
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Keywords: Diabetic neuropathies
Diabetic foot
Foot ulcer
Longitudinal studies
Plantar pressure
Issue Date: 23-Oct-2015
Publisher: BioMed Central
Citation: Fernando M, Crowther R, Cunningham M, Lazzarini P, Sangla K & Golledge J (2015) Lower limb biomechanical characetristics of patients with neuropathic diabetic foot ulcers: The diabetes foot ulcer study protocol, BMC Endocrine Disorders, 15, Art. No.: 59.
Abstract: Background  Foot ulceration is the main precursor to lower limb amputation in patients with type 2 diabetes worldwide. Biomechanical factors have been implicated in the development of foot ulceration; however the association of these factors to ulcer healing remains less clear. It may be hypothesised that abnormalities in temporal spatial parameters (stride to stride measurements), kinematics (joint movements), kinetics (forces on the lower limb) and plantar pressures (pressure placed on the foot during walking) contribute to foot ulcer healing. The primary aim of this study is to establish the biomechanical characteristics (temporal spatial parameters, kinematics, kinetics and plantar pressures) of patients with plantar neuropathic foot ulcers compared to controls without a history of foot ulcers. The secondary aim is to assess the same biomechanical characteristics in patients with foot ulcers and controls over-time to assess whether these characteristics remain the same or change throughout ulcer healing.  Methods/Design  The design is a case–control study nested in a six-month longitudinal study. Cases will be participants with active plantar neuropathic foot ulcers (DFU group). Controls will consist of patients with type 2 diabetes (DMC group) and healthy participants (HC group) with no history of foot ulceration. Standardised gait and plantar pressure protocols will be used to collect biomechanical data at baseline, three and six months. Descriptive variables and primary and secondary outcome variables will be compared between the three groups at baseline and follow-up.  Discussion  It is anticipated that the findings from this longitudinal study will provide important information regarding the biomechanical characteristic of type 2 diabetes patients with neuropathic foot ulcers. We hypothesise that people with foot ulcers will demonstrate a significantly compromised gait pattern (reduced temporal spatial parameters, kinematics and kinetics) at base line and then throughout the follow-up period compared to controls. The study may provide evidence for the design of gait-retraining, neuro-muscular conditioning and other approaches to off-load the limbs of those with foot ulcers in order to reduce the mechanical loading on the foot during gait and promote ulcer healing.
Type: Journal Article
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Rights: © Fernando et al. 2015 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Affiliation: James Cook University
James Cook University
NMAHP Research
Queensland University of Technology
Queensland Health
James Cook University

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