Dynamic first metatarsophalangeal joint movement in diabetes foot assessment of type 2 diabetic women

Background: Limited joint mobility is a recognised complication of diabetes mellitus. The relationship between passive and active range of motion and the risk of ulceration related to peak plantar pressure in clinical assessment has not been investigated. Methods: This study examined the relationship between passive and dynamic testing for joint mobility and the relationship to plantar pressure in a group of thirty females (15 controls; 15 diabetics) attending an Allied Health Clinic. Results: Our results indicate that despite a statistically significant (p<0.05) lower passive dorsiflexion (33.88±12.98°) in diabetic females (9.2±3.6 yrs duration), and good level of diabetes control (HbA1c: 7.08±0.9) compared to the control group dorsiflexion (40.56±14.57°), dynamic mobility was not affected (45.53±9.06° and 43.78±12.56°, p>0.05; diabetes and controls respectively). No statistical significant difference was observed for either the first metatarsal head or for the hallux peak plantar pressure. Discussion: Compounding factors of limited joint range of motion and increased peak plantar pressure have been shown to increase the incidence of planar ulceration in people with diabetes. However our results indicate that for females with short-term diabetes and well controlled sugar levels, a decrease in passive joint mobility test result may not be a significant indicator of an increased risk of ulceration as dynamic dorsiflexion is not decreased and peak plantar pressure are not affected. This is of importance in clinical practice as it requires changes in assessment.