{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:02:45Z","timestamp":1792648965043,"version":"4.5.0"},"reference-count":42,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2005,6,22]],"date-time":"2005-06-22T00:00:00Z","timestamp":1119398400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetic Medicine"],"published-print":{"date-parts":[[2005,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Aim\u2003<\/jats:bold> The aim of this study was to examine foot function in the presence of diabetes\u2010induced alterations of the anatomical and biomechanical unit formed by the Achilles tendon, plantar fascia and metatarso\u2010phalangeal joints. More specifically, we focused on the Windlass mechanism, the physiological mechanism which entails stiffening of the foot during propulsion.<\/jats:p><jats:p><jats:bold>Methods\u2003<\/jats:bold> Sixty\u2010one diabetic patients, with or without neuropathy, and 21 healthy volunteers were recruited. The thickness of Achilles tendon and plantar fascia was measured by ultrasound. The main biomechanical parameters of foot\u2013floor interaction during gait were acquired by means of dedicated platforms. The range of motion of the 1st metatarso\u2010phalangeal joint was measured passively.<\/jats:p><jats:p><jats:bold>Results\u2003<\/jats:bold> The plantar fascia (PF) and Achilles tendon (AT) were significantly thickened in diabetic patients [control subjects: PF 2.0\u00a0\u00b1\u00a00.5\u00a0mm, AT 4.0\u00a0\u00b1\u00a00.5\u00a0mm; diabetic patients without neuropathy: PF 2.9\u00a0\u00b1\u00a01.2\u00a0mm (<jats:italic>P\u00a0=<\/jats:italic>\u00a00.002), AT 4.6\u00a0\u00b1 1.0\u00a0mm (<jats:italic>P\u00a0=<\/jats:italic>\u00a00.016); diabetic patients with neuropathy: PF 3.0\u00a0\u00b1\u00a00.8\u00a0mm (<jats:italic>P\u00a0&lt;<\/jats:italic> 0.0001), AT 4.9\u00a0\u00b1\u00a01.7\u00a0mm (<jats:italic>P\u00a0=<\/jats:italic>\u00a00.026)]. Joint mobility was significantly reduced [control subjects: 100.0\u00a0\u00b1\u00a010.0\u00b0; diabetic patients without neuropathy: 54.0\u00a0\u00b1 29.4\u00b0 (<jats:italic>P\u00a0&lt;<\/jats:italic>\u00a00.0001); diabetic patients with neuropathy: 54.9\u00a0\u00b1\u00a017.2\u00b0 (<jats:italic>P\u00a0&lt;<\/jats:italic>\u00a00.0001)]. Loading times and force integrals under the heel and the metatarsals increased [metatarsal loading time (% stance phase): control subjects 88.2\u00a0\u00b1 4.1%; diabetic patients without neuropathy 90.1\u00a0\u00b1\u00a04.7% (<jats:italic>P\u00a0=<\/jats:italic>\u00a00.146); diabetic patients with neuropathy 91.7\u00a0\u00b1\u00a06.6% (<jats:italic>P\u00a0=<\/jats:italic>\u00a00.048)].<\/jats:p><jats:p><jats:bold>Conclusions\u2003<\/jats:bold> Increased thickness of Achilles tendon and plantar fascia, more evident in the presence of neuropathy, may contribute to an overall increase of tensile force and to the occurrence of an early Windlass mechanism, maintained throughout the whole gait cycle. This might play a significant role in the overall alteration of the biomechanics of the foot\u2013ankle complex.<\/jats:p>","DOI":"10.1111\/j.1464-5491.2005.01699.x","type":"journal-article","created":{"date-parts":[[2005,12,1]],"date-time":"2005-12-01T14:50:04Z","timestamp":1133448604000},"page":"1713-1719","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism"],"prefix":"10.1111","volume":"22","author":[{"given":"E.","family":"D\u2019Ambrogi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Giacomozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Macellari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Uccioli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2005,6,22]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0954-6820.1957.tb15511.x"},{"key":"e_1_2_7_3_2","first-page":"42","volume-title":"Anatomy and Human Movement.","author":"Palastanga N","year":"1989"},{"key":"e_1_2_7_4_2","first-page":"556","volume-title":"Anatomy of the Foot and Ankle","author":"Sarrafian S","year":"1993"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-5491.2002.00850.x"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070002100104"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079501600707"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1067-2516(97)80072-5"},{"key":"e_1_2_7_9_2","unstructured":"MuellerMJ MalufK SinacoreDR HastingsM StrubeMJ EngsbergJet al.Effect of tendo Achilles lengthening on forefoot plantar pressures ankle motion and plantar flexor power during walking in subjects with diabetes and peripheral neuropathy: a prospective controlled clinical trial.Procs VIII EMED Scientific Meeting\u2014Kananaskis Alberta Canada July 31st\u2013August 3rd 2002:25."},{"key":"e_1_2_7_10_2","first-page":"25","article-title":"The mechanics of the foot. II. The plantar aponeurosis and the arch","volume":"88","author":"Hicks JH","year":"1954","journal-title":"J Anat"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1159\/000141055"},{"key":"e_1_2_7_12_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/00003086-198307000-00003","article-title":"Gait anatomy and biomechanics of the hindfoot","volume":"177","author":"Perry J","year":"1983","journal-title":"Clin Orthop"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0268-0033(96)00070-8"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070002100306"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(94)00163-X"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1350-4533(03)00029-8"},{"key":"e_1_2_7_17_2","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1177\/107110070302400307","article-title":"The in vivo elastic properties of the plantar fascia during the contact phase of walking","volume":"24","author":"Gefen A","year":"2003","journal-title":"Foot Ankle Int"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00400697"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.1986.tb00775.x"},{"key":"e_1_2_7_20_2","first-page":"137","article-title":"Piezo\u2010dynamometric platform for a more complete analysis of foot\u2010of\u2010floor interaction","volume":"5","author":"Giacomozzi C","year":"1998","journal-title":"IEEE Trans Rehabil Eng"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02511242"},{"key":"e_1_2_7_22_2","first-page":"137","article-title":"International protocol guidelines for plantar pressure measurement","volume":"1","author":"Barnett S","year":"1998","journal-title":"Diabetic Foot"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0268-0033(01)00015-8"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0966-6362(99)00021-1"},{"key":"e_1_2_7_25_2","unstructured":"Shao QM.Multivariate statistical methods. In:Lecture Notes for Math 2427\/527 2004Available from:http:\/\/darkwing.uoregon.edu\/~qmshao\/427\/427lect15.pdf."},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.2307\/1924341"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/esp.387"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.8.1451"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.2337\/diab.45.4.440"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001250050788"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9290(98)00188-2"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1056-8727(98)00024-5"},{"key":"e_1_2_7_33_2","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.2106\/00004623-200208000-00016","article-title":"Structural changes in the forefoot of individuals with diabetes and a prior plantar ulcer","volume":"84","author":"Robertson DD","year":"2002","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_7_34_2","first-page":"31","article-title":"Assessment of the diabetic foot using spiral computed tomography imaging and plantar pressure measurements: a technical report","volume":"37","author":"Smith KE","year":"2000","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_7_35_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.5.1525"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9290(86)90116-8"},{"key":"e_1_2_7_37_2","first-page":"132","article-title":"Connective tissue abnormalities in diabetes mellitus","volume":"18","author":"Crisp AJ","year":"1984","journal-title":"J R Physicians Lond"},{"key":"e_1_2_7_38_2","first-page":"432","article-title":"Biomechanical changes in connective tissues induced by experimental diabetes","volume":"98","author":"Andreassen TT","year":"1981","journal-title":"Acta Endocrinol (Copenh)"},{"key":"e_1_2_7_39_2","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1093\/ptj\/82.4.383","article-title":"Tissue adaptation to physical stress. a proposed \u2018Physical Stress Theory\u2019 to guide physical therapist practice, education, and research","volume":"82","author":"Mueller MJ","year":"2002","journal-title":"Phys Ther"},{"key":"e_1_2_7_40_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.20.12.1904"},{"key":"e_1_2_7_41_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.21.11.1955"},{"key":"e_1_2_7_42_2","first-page":"563","article-title":"Voluntary activation of human motor axons in the absence of muscle afferent feedback. The control of the deafferented hand","volume":"113","author":"Gandevia SC","year":"1993","journal-title":"Brain"},{"key":"e_1_2_7_43_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002210050371"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1464-5491.2005.01699.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1464-5491.2005.01699.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T12:22:30Z","timestamp":1696940550000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1464-5491.2005.01699.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,6,22]]},"references-count":42,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2005,12]]}},"alternative-id":["10.1111\/j.1464-5491.2005.01699.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1464-5491.2005.01699.x","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,6,22]]},"assertion":[{"value":"2005-06-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}