Functional outcome in people with diabetic neuropathy at four stages of foot complications.

This study was designed to investigate the nature of the course of functional outcome across the four patient groups with diabetic neuropathy at consequent stages of foot complications namely: diabetic neuropathy without history of plantar ulceration (DMPN), active plantar ulceration (DFU), healed unilateral partial foot amputations (PFA) and healed unilateral trans-tibial amputations (TTA). The secondary objective was to compare the functional outcome between patients with DFU and PFA and patients with PFA and TTA. Methods: In this cross-sectional case control study, 4 matched groups of patients with DMPN were studied: DMPN (n=23); DFU (n=23); PFA (n=16) and TTA (n=22). Appropriate outcome measures were used to evaluate function in 3 domains, namely Mobility and its impact on weight-bearing (sit-to-stand, standing balance, gait and plantar pressures during walking), Level of Activity (capacity and performance of walking) and H-RQOL. One-way ANOVA was used to compare 4 groups and linear polynomial contrast detected the trend across groups. In cases of significant difference between the 4 groups, an Independent sample t-test was used for specific group comparison. Results: There was a significant difference in functional outcome between the four groups demonstrating an overall decline in the level of function with the progression of impairment (standing balance: p=0.002, gait velocity: p<0.001, daily strides: p<0.001, SF-36 Physical function: p<0.001). The risk of plantar injury to the entire affected foot during walking increased from DMPN to DFU to PFA (p=0.013). There was no significant difference between the overall function of DFU and PFA. The PFA and TTA groups also varied significantly only in the domain of activity performance wherein the TTA group demonstrated a low daily walking performance compared to the PFA group (p=0.006). Conclusion: The overall decline demonstrated in this study in the three domains of function with progression of physical impairment