Gait and Plantar Pressure Analysis in Charcot Neuroarthropathy: A Clinic-Based Biomechanical Study.

Introduction

Charcot Neuroarthropathy (CN) is a progressive joint disorder resulting from peripheral neuropathy and repetitive microtrauma. Management prioritizes offloading to prevent deformity, ulceration, infection, and amputation. While three-dimensional gait analysis can be useful for disease staging and guiding management, its cost and limited accessibility limit routine clinical use. This study evaluated plantar pressure and two-dimensional gait kinematics in CN patients using a relatively low-cost clinic-based approach.

Methods

Following institutional review board approval, this cross-sectional observational study was conducted at a single institution between July and December 2024. Nine patients with clinically diagnosed unilateral CN and 11 Healthy controls were enrolled. Participants walked at 1.0 mph on a treadmill wearing diabetic slippers equipped with insole pressure sensors and markers placed on standardized lower-extremity landmarks. Peak plantar pressures were calculated for each step and averaged within predefined regions of interest (forefoot, metatarsals, midfoot, and hindfoot); median region-specific values were used for group comparisons. The hip, knee, and ankle joint range of motion (ROM) were also assessed. Comparisons were made between affected and contralateral CN limbs, and between each of these limbs and Healthy controls.

Results

Affected limbs demonstrated significantly higher midfoot and significantly lower forefoot, hindfoot, and metatarsal plantar pressures than Healthy controls (Benjamini-Hochberg adjusted p < 0.05 for all four regions). Knee ROM was significantly reduced in both affected and contralateral limbs compared with Healthy controls (adjusted p < 0.05 for both), whereas hip and ankle ROM did not differ significantly across groups. No affected-versus-contralateral differences survived correction for multiple comparisons in either plantar pressure or kinematic outcomes.

Conclusions

CN participants exhibited reduced knee ROM and altered regional plantar pressures consistent with midfoot collapse, with reduced knee ROM also evident in the contralateral limb, supporting bilateral involvement in CN. These findings support the utility of clinic-based integrated gait analysis as an adjunctive tool for characterizing CN and informing clinical management.

Keywords

charcot neuroarthropathy, diabetes mellitus, gait analysis, neuropathy, plantar pressure