Movement & Musculoskeletal Problems in Diabetes

We are investigating how movement and metabolic factors contribute to musculoskeletal problems in people with diabetes mellitus. We aim to minimize limited joint mobility, weakness, skin breakdown, pain, and disability for this high risk population.

Michael Mueller foot lab. PT

Dr. Mueller is interested in the movement and metabolic factors that contribute to injury and tissue adaptation in people with chronic diseases, particularly people with diabetes and peripheral neuropathy. We have documented important factors which contribute to injury (ulcer) and healing on the feet of people with diabetes mellitus and peripheral neuropathy with a primary goal to reduce the incidence of skin break down and lower extremity amputations in this high risk population. More recently, we also have been investigating upper extremity disability in people with diabetes, especially the common metabolic and movement factors that affect both the foot and arm (i.e., elevated advanced glycated end products, limited joint mobility). In addition, Dr. Mueller is passionate about training young investigators in rehabilitation research. He served as the PI for an NCMRR T32 training award for many years and currently is the PI on the Comprehensive Opportunities for Rehabilitation Research Training (CORRT; K12 HD055931).

Faculty Investigator

Michael Mueller, PT, PhD, FAPTA

Staff

Kay Bohnert, MS
Chris Sorensen, PhD, MSCI
Darrah Snozek

Student Members

Emily Martin, DPT Student
Jessica Renz, DPT Student
Rose Reida, DPT Student

Current Research Studies

Diabetic Upper Extremity Pathophysiology, Limited Joint Mobility and Disability
Funding Souce: NIH R21DK100793

Diabetes affects collagen tissue and contributes to “limited joint mobility” (LJM) due to an excess of Advanced Glycated End products (AGEs). We believe that excessive collagen cross linking in tendons, ligaments, and skin leads to increased thickness of these tissues and affects movement. The primary goal of this project is to determine how AGE accumulation and shoulder movement (humeral thoracic range of motion and “activity count”) interact to contribute to shoulder LJM, pain, and disability, and if an intervention consisting of a tailored dose of stretching and active shoulder movement can reduce these problems in people with diabetes mellitus. This project will use an innovative and noninvasive imaging measure (skin intrinsic fluorescence) as a biomarker for AGE levels in the skin, three dimensional motion analysis to quantify limited motion of the glenohumeral joint, and accelerometers to quantify shoulder “activity count” throughout the day.

Collaborative Research Studies

movement problems in diabetes

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Muscle, Joint, and Movement Deterioration Contributing to Neuropathic Forefoot Deformity
Funding Source: NIH R01 DK10780 (PI: Mary K. Hastings)

The focus of this study is to understand better how the potentially modifiable factors of excessive AGEs, intrinsic foot muscle deterioration, limited ankle dorsiflexion range of motion, and movement patterns combine to cause metatarsophalangeal joint (MTPJ) deformities that are precursors to skin breakdown and amputation.

Microcirculatory Function in Diabetic Foot Muscles with MRI
Funding Source: R01 DK105322; (Co-PI: Jie Zheng and Mary Hastings)

The objective of this study is to translate MRI techniques to characterize the skeletal muscle microcirculation in calf and foot muscles in groups of patients with diabetes, with and without ulcers. The long term goal is to promote microcirculation as a prime evaluation target before embarking on interventional treatment for limb preservation in patients with diabetes.

Carbon Fiber Offloading Ankle-Foot Orthoses
Funding Source: NIH R41DK109731; (Co-PI: Michael Dailey M & Dequan Zou)

This project will further develop a carbon-fiber ankle foot orthosis designed to offload plantar pressures and optimize patient function through maximizing plantar flexor power production for patients with diabetes, peripheral neuropathy, and a high risk of skin breakdown.

Past Research Studies

Effect of Weight-Bearing Exercise on People with Diabetes and Neuropathic Feet ( R21 HD058938)

Achilles Tendon Lengthening on Patients with Diabetes (NIH RO1-HD36902)

Visualizing Diabetic Feet to Optimize Orthotic Fitting (NIH R01 HD036895)

Footwear for Patients with Transmetatarsal Amputation (NIH RO1 HD 31486)

In-shoe Multisensory Data Acquisition and Analysis (RO1 HD36576-01)