The pattern of tibial nerve excursion with active ankle dorsiflexion is different in older people with diabetes mellitus

Boyd, Benjamin S, Gray, Andrew T, Dilley, Andrew, Wanek, Linda and Topp, Kimberly S (2012) The pattern of tibial nerve excursion with active ankle dorsiflexion is different in older people with diabetes mellitus. Clinical Biomechanics, 27 (9). pp. 967-971. ISSN 0268-0033

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Abstract

Background
The peripheral nervous system has an inherent capability to tolerate the gliding (excursion), stretching (increased strain), and compression associated with limb motions necessary for functional activities. The biomechanical properties during joint movements are well studied but the influence of other factors such as limb pre-positioning, age and the effects of diabetes mellitus are not well established for the lower extremity. The purposes of this pilot study were to compare the impact of two different hip positions on lower extremity nerve biomechanics during an active ankle dorsiflexion motion in healthy individuals and to determine whether nerve biomechanics are altered in older individuals with diabetes mellitus.

Methods
Ultrasound imaging was used to quantify longitudinal motion of the tibial nerve and transverse plane motion of the tibial and common fibular nerves in the popliteal fossa during active ankle movements.

Findings
In healthy individuals, ankle dorsiflexion created mean tibial nerve movement of 2.18mm distally, 1.36mm medially and 3.98mm superficially. When the hip was in a flexed position there was a mean three-fold reduction in distal movement. In people with diabetes mellitus there was significantly less distal movement of the tibial nerve in the neutral hip position and less superficial movement of the nerve in both hip positions compared to healthy individuals.

Interpretation
We have documented reductions in tibial nerve excursion due to limb pre-positioning thought to pre-load the nervous system using a non-invasive methodology. Thus, lower limb pre-positioning impacts nerve biomechanics during ankle motions common in functional activities. Additionally, our findings indicate that nerve biomechanics have the potential to be altered in older individuals with diabetes mellitus compared to younger healthy individuals.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Clinical Medicine
Subjects: R Medicine > RC Internal medicine > RC0581 Specialties of internal medicine > RC1200 Sports medicine
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Depositing User: Ellen Thomas
Date Deposited: 31 Oct 2012 15:31
Last Modified: 31 Oct 2012 15:31
URI: http://sro.sussex.ac.uk/id/eprint/41069
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