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Functional Limitations in Patients With Diabetes and Transmetatarsal Amputations

MJ Mueller, PhD, PT, is Assistant Professor, Program of Physical Therapy, Washington University School of Medicine, Box 8502, 4444 Forest Park Blvd, St Louis, MO, 63110 (USA) (muellerm@medicine.wustl.edu).
GB Salsich, PT, is a physical therapist and doctoral student in the Interdisciplinary Program in Movement Science, Washington University.
MJ Strube, PhD, is Professor, Department of Psychology, Washington University.

Background and Purpose. Reports in the surgical and rehabilitation literature suggest that patients with transmetatarsal amputations (TMAs) function well with regular shoes and a toe filler. Functional limitations, however, have not been documented in this population. The purpose of this study was to compare the function of patients with diabetes mellitus (DM) and TMA with that of age- and gender-matched control subjects. Subjects. Thirty subjects (15 subjects with DM and TMAs and 15 control subjects), with a mean age of 62.3 years (SD=9.2, range=43–83), were studied. Methods. Function was measured using the Functional Reach Test (FRT), the Physical Performance Test (PPT), walking speed for 15.2 m (50 ft), and the Sickness Impact Profile (SIP). Subjects in the TMA-DM group wore standard shoes with a toe filler. Results. The TMA-DM group scored lower (mean±standard deviation) than did the control group on all tests (FRT: 19.1±8.6 vs 31.5±9.1 cm [7.5±3.4 vs 12.4±3.6 in]; PPT: 18.7±4.8 vs 24.1±2.2 points [28 points possible]; walking speed: 51.5±13.2 vs 75.6±9.3 m/min; SIP: 17.0±12.7 vs 3.7±4.7). Conclusion and Discussion. Persons with DM and TMAs have considerable functional limitations. Research is needed to determine whether therapeutic footwear or other forms of rehabilitation can improve their function.

Key Words: Diabetes mellitus • Foot • Function • Rehabilitation

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