INTRODUCTION
Diabetic neuropathy and the resulting partial foot amputation cause gait alterations, including slower gait velocity, greater step variability, greater inter-limb asymmetry, and altered ground reaction force (GRF)1. These biomechanical alterations with impaired walking capacity increase the risk of falls as well as musculoskeletal comorbidities, including osteoarthritis in the contralateral limb2, leading to loss of functional independence.
As partial foot amputation-induced gait alterations are prominent in proximal amputation due, at least in part, to loss of moment arm3, surgical techniques have been proposed to save the foot and prolong the bipedal ambulatory function. However, the currently available data regarding partial toe amputation patients are limited. For example, patients who have undergone first ray amputation display slower gait velocity, reduced step length, greater step variability, and decreased hip extension4. To date, no study has investigated the influence of non-first ray toe amputation on gait alterations in patients with diabetic neuropathy.
Herein, we report the case of a patient who had undergone non-first ray but multiple toe amputation, in who integrated gait analysis was performed to assess spatiotemporal parameters, kinetics, and kinematics. We demonstrated that multiple toe amputation caused a lack of push-off with decreased hip extension in the ipsilateral limb accompanied by elevated contralateral GRF. This single case study provides insight into toe amputation-related biomechanical alterations and serves as a framework for future studies to establish an effective rehabilitative strategy and prevent musculoskeletal comorbidities following amputation. The patient was informed that data concerning the case would be submitted for publication, and he consented to it.