Abstract
BackgroundSeveral prospective studies have suggested that gait and plantar pressure abnormalities secondary to diabetic peripheral neuropathy contributes to foot ulceration. There are many different methods by which gait and plantar pressures are assessed and currently there is no agreed standardised approach. This study aimed to describe the methods and reproducibility of three-dimensional gait and plantar pressure assessments in a small subset of participants using pre-existing protocols.MethodsFourteen participants were conveniently sampled prior to a planned longitudinal study; four patients with diabetes and plantar foot ulcers, five patients with diabetes but no foot ulcers and five healthy controls. The repeatability of measuring key biomechanical data was assessed including the identification of 16 key anatomical landmarks, the measurement of seven leg dimensions, the processing of 22 three-dimensional gait parameters and the analysis of four different plantar pressures measures at 20 foot regions.ResultsThe mean inter-observer differences were within the pre-defined acceptable level (<7 mm) for 100 % (16 of 16) of key anatomical landmarks measured for gait analysis. The intra-observer assessment concordance correlation coefficients were > 0.9 for 100 % (7 of 7) of leg dimensions. The coefficients of variations (CVs) were within the pre-defined acceptable level (<10 %) for 100 % (22 of 22) of gait parameters. The CVs were within the pre-defined acceptable level (<30 %) for 95 % (19 of 20) of the contact area measures, 85 % (17 of 20) of mean plantar pressures, 70 % (14 of 20) of pressure time integrals and 55 % (11 of 20) of maximum sensor plantar pressure measures.ConclusionOverall, the findings of this study suggest that important gait and plantar pressure measurements can be reliably acquired. Nearly all measures contributing to three-dimensional gait parameter assessments were within predefined acceptable limits. Most plantar pressure measurements were also within predefined acceptable limits; however, reproducibility was not as good for assessment of the maximum sensor pressure. To our knowledge, this is the first study to investigate the reproducibility of several biomechanical methods in a heterogeneous cohort.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0135-8) contains supplementary material, which is available to authorized users.
Highlights
Several prospective studies have suggested that gait and plantar pressure abnormalities secondary to diabetic peripheral neuropathy contributes to foot ulceration
This study aimed to describe the reproducibility of one operator in performing key measurements needed for three dimensional gait and plantar pressure assessments using standard protocols
The findings suggest that following extensive training, a junior operator can obtain the necessary skills to accurately identify key anatomical landmarks and measure leg dimensions needed for gait analyses
Summary
Several prospective studies have suggested that gait and plantar pressure abnormalities secondary to diabetic peripheral neuropathy contributes to foot ulceration. Studies examining the biomechanical factors influencing foot ulcer healing need to perform repeated assessments over time in the same patients [5]. There is a need to better describe the reproducibility of methods used to acquire gait and plantar pressure data and to define ways to minimise measurement error [7, 11,12,13]. This is especially important prior to interpreting results of studies in which gait is being assessed repeatedly over time, since measurement error will need to be taken into account [7]
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