Academic journal article Journal of Social Welfare and Management

Impact and Influence of Joint Mobility Impairment in Diabetic Peripheral Neuropathy: Implications for Social Welfare and Management

Academic journal article Journal of Social Welfare and Management

Impact and Influence of Joint Mobility Impairment in Diabetic Peripheral Neuropathy: Implications for Social Welfare and Management

Article excerpt


Epidemiological triad for diseases in the field of public health includes the agent, host and environment that are collectively regarded as the social determinants of health and disease, which play a large part in the stimulusresponse inter-relationship manifesting upon a structure-function continuum.[1] One such important social determinant is functional mobility which is dependent upon physiological[2] and pathophysiological[3] adaptations in spinal and peripheral joint mobility.

Joints form the basis for structural and functional mobility by providing link for moving bones, acting as fulcrum for contracting muscles, and acting as shockabsorbers in force distribution between rigid bony segments.[4,5,6] Synovial joints are the commonest type of joints which are recognized for their structural features of presence of synovial membrane and fluid, and functional features of stability and mobility. [7]

Upper extremity joints are well adapted to perform fine, precise skilled movements of picking up, carrying and transfering objects whilst lower extremity joints are well adapted to perform powerful quick weight-bearing movements. [8] Upper limb joints enable a person' activities of daily living such as eating, grooming and self-care whereas lower limb joints enable walking, functional ambulation, stair climbing and running. [9]

Joint mobility and its dysfunction is one of the leading impairments in body structure and function as recommended for International classification of functioning, disability and health (ICF) model of the World Health Organization (WHO). [10] Evaluation of joint mobility is an integral part of holistic disability evaluation in all medical conditions for people of all ages. [11]

Physical examination of joint mobility involve static and dynamic measures of alignment, active and passive physiological movement testing, joint play or accesory movement testing, and functional mobility testing during gait and other activities.[12] Disorders and dysfunction of joints lead to mobility impairments which present either as hypomobility (reduced mobility) or hypermobility (excessive mobility) of that particular joint tested on clinical examination. [13]

Inflammatory, dgenerative and autoimmune connective tissue disorders leading symptoms and signs of joint dysfunction such as joint pain, swelling, stiffness and deformity, with or without sounds (clicks, crepitus), locking and loss of function. [14] Although joint dysfunction occurs primarily due to musculoskeletal disorders, other physiological (ageing) and pathological conditions that cause secondary manifestation of joint dysfunction are neurological disorders that affect central and peripheral nervous systems. [15]

The 34 joints of the human foot and ankle form the base for stability and also enhance force distribution between body and the supporting surface, which is essential for almost all activities that involve standing, walking and/or running that are essential in regular social participation and contribution by an individual. [16,17] Joints are innervated by afferent sensory neurons [18] which when affected in peripheral nerve disorders lead to senseless or painless joints termed as neuropathic joints or neuroarthropathy or Charcot joints. [19]

Charcot's joints or Charcot neuroarthropathy is a leading complication of foot neuropathies which affect the individual's participation restriction is influenced by activity limitations and impairments in body structure and function due to its multidimensional manifestations.[20] Diabetic neuroarthropathy is a common form of Charcot arthropathy which is highly prevalent due to higher prevalence of its etiologically primary metabolic disorder globally. [21]

Whilst the cause for neuroarthropathy is neuropathy, diabetic neuroarthropathy is caused due to diabetic neuropathy and is often an overlooked complication in people with diabetes.[22] Early identification is thus essential in order to initiate appropriate management to prevent deformities and reduce the risk for amputations. …

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