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Decreased stiffness at the ankle joint in patients with long-term Type 1 diabetes

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Abstract Aims 

To evaluate contractile and reflex properties of the soleus muscle together with ankle joint stiffness in long-term Type 1 patients. Methods 

Stretch reflex and muscle function of the soleus muscle was tested in 15 Type 1 diabetes mellitus patients and 15 controls. M-wave amplitude and maximal twitch torque was elicited by supramaximal stimulation of the tibial nerve. The stretch reflex was elicited by a 4° rotation of the ankle. Results 

Rise time and fall time of the maximal twitch torque were increased compared with controls. The amplitude of the short latency stretch reflex was significantly reduced in patients at contraction levels of 5–30 Nm. At a contraction level of 5 Nm the median stretch reflex threshold was 10°/s in patients and 6°/s in controls (P = 0.03). Stiffness was decreased in diabetic patients, especially at lower contraction levels. There was no significant correlation between the clinical neuropathy score and stiffness. In contrast, high neuropathy score was correlated with low amplitude of the reflex amplitude ( = −0.51, P = 0.05). Conclusions 

We demonstrate altered contractile properties, a decrease in stretch reflex of the soleus muscle, and a reduced stiffness at the ankle joint in patients with long-term Type 1 diabetes. These changes may cause delayed muscle contraction and impaired reflex modulation which could contribute to gait disturbances and increased number of falls in diabetic patients. Diabet. Med. 21, 539–544 (2004)
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Keywords: ankle joint; long-term type 1 diabetes; soleus muscle; stiffness; stretch reflex

Document Type: Research Article

Affiliations: 1: Department of Neurology, Aarhus University Hospital, Aarhus 2: Centre for Sensory–Motor Interaction, Aalborg University, Aalborg, Denmark

Publication date: June 1, 2004

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