Differences in the Gait Characteristics of Patients With Diabetes and Peripheral Neuropathy Compared With Age-Matched Controls (original) (raw)
Related papers
PREDICTIVE FACTORS OF GAIT IN NEUROPATHIC AND NON-NEUROPHATIC DIABETIC PATIENTS
The purpose of this study was to analyze the range of movement of the ankle and the vertical ground reaction force involved in gait among diabetic patients with and without peripheral neuropathy. Sample and Method: 36 individuals were divided into three groups: Control group – CG: 10 individuals without diabetes, Diabetic group – DG: 10 individuals with diabetes without peripheral neuropathy and Neuropathy, and Diabetic neuropathic group – DNG: 16 individuals with diabetes and peripheral diabetic neuropathy. Gait - AMTI® OR6/6m and range of tibiotarsal joint movement – System Vicom 640® was carried out in all the participants. Results: The first and second vertical ground reaction force peaks were statistically higher in the neuropathy group, and the range of ankle motion was lower in the Diabetes and Neuropathy groups. Conclusion: The range of movement of the tibiotarsal joint is lower in diabetics, regardless of the presence or absence of peripheral neuropathy, and diabetics with peripheral neuropathy show an increase in the first and second vertical ground reaction force peaks during walking.
Walking performance in people with diabetic neuropathy: benefits and threats
Diabetologia, 2006
Aims/hypothesis Walking is recommended as an adjunct therapy to diet and medication in diabetic patients, with the aim of improving physical fitness, glycaemic control and body weight reduction. Therefore we evaluated walking activity on the basis of capacity, performance and potential risk of plantar injury in the diabetic population before it can be prescribed safely. Subjects, materials and methods Twenty-three subjects with diabetic neuropathy (DMPN) were compared with 23 patients with current diabetic foot ulcers, 16 patients with partial foot amputations and 22 patients with trans-tibial amputations. The capacity for walking was measured using a total heart beat index (THBI). Gait velocity and average daily strides were measured to assess the performance of walking, and its impact on weight-bearing was studied using maximum peak pressure. Results THBI increased (p<0.01) and gait velocity and daily stride count fell (p<0.001 for both) with progression of foot complications. The maximum peak pressures over the affected foot of patients with diabetic foot ulcers (p<0.05) and partial foot amputations (p<0.01) were higher than in the group with DMPN. On the contralateral side, the diabetic foot ulcer group showed higher maximum peak pressure over the total foot (p<0.05), and patients with partial foot amputations (p<0.01) and trans-tibial amputations (p<0.05) showed higher maximum peak pressure over the heel. Conclusions/interpretation Walking capacity and performance decrease with progression of foot complications. Although walking is recommended to improve fitness, it cannot be prescribed in isolation, considering the increased risk of plantar injury. For essential walking we therefore recommend the use of protective footwear. Walking exercise should be supplemented by partial or non-weightbearing exercises to improve physical fitness in diabetic populations.
Walking Strategy in Diabetic Patients With Peripheral Neuropathy
Diabetes Care, 2002
OBJECTIVE—Diabetic neuropathic patients show a peculiar loading pattern of the foot, which led us to hypothesize that a substantial modification exists in their deambulatory strategy. The aim of the present study was to support this hypothesis by quantifying the changes of the loading patterns and by monitoring the excursion of center of pressure (COP) during gait. RESEARCH DESIGN AND METHODS—A total of 21 healthy volunteers (C) and 61 diabetic patients were evaluated: 27 diabetic subjects without neuropathy (D), 19 with neuropathy (DN), and 15 with previous neuropathic ulcer (DPU). A piezo-dynamometric platform was used to record the foot-to-floor interaction by measuring loading time and the instantaneous COP position during the stance phase of gait. RESULTS—Loading time was significantly longer in neuropathic patients than in control subjects (DPU: 816.8 ± 150 ms; DN: 828.6 ± 152 ms; D: 766.5 ± 89.9 ms; C: 723.7 ± 65.7 ms; P < 0.05). COP excursion along the medio-lateral axis ...
Effect of Type II diabetic peripheral neuropathy on gait termination in the elderly
Diabetologia, 2001
Human locomotion is well documented, including gait changes due to different pathologies and normal ageing [1±3]. Most of the published literature focuses, however, on steady-state locomotion: The participants are analysed while walking at a normal rhythm. But locomotion is not limited to steady-state body transportation. It needs to be adapted to a permanently changing environment and therefore requires an efficient control of postural stability. Velocity changes and stopping are examples of such adaptive processes. Despite the fact that daily activities require the ability to stop, only a handful of studies have investigated gait termination processes [4±6]. Terminating gait puts special demands on postural control, as a transition occurs from a dynamic situation (walking) to a quasi-static situation (standing).
Clinical Biomechanics, 2013
Background: Reduction in foot mobility has been identified as a key factor of altered foot biomechanics in individuals with diabetes mellitus. This study aimed at comparing in vivo segmental foot kinematics and coupling in patients with diabetes with and without neuropathy to control adults. Methods: Foot mobility of 13 diabetic patients with neuropathy, 13 diabetic patients without neuropathy and 13 non-diabetic persons was measured using an integrated measurement setup including a plantar pressure platform and 3D motion analysis system. In this age-, sex-and walking speed matched comparative study; differences in range of motion quantified with the Rizzoli multisegment foot model throughout different phases of the gait cycle were analysed using one-way repeated measures analysis of variance (ANOVA). Coupling was assessed with cross-correlation techniques. Findings: Both cohorts with diabetes showed significantly lower motion values as compared to the control group. Transverse and sagittal plane motion was predominantly affected with often lower range of motion values found in the group with neuropathy compared to the diabetes group without neuropathy. Most significant changes were observed during propulsion (both diabetic groups) and swing phase (predominantly diabetic neuropathic group). A trend of lower cross-correlations between segments was observed in the cohorts with diabetes. Interpretation: Our findings suggest an alteration in segmental kinematics and coupling during walking in diabetic patients with and without neuropathy. Future studies should integrate other biomechanical measurements as it is believed to provide additional insight into neural and mechanical deficits associated to the foot in diabetes.
Journal of the American Podiatric Medical Association, 2013
Background:We explored gait differences in patients with diabetes and peripheral neuropathy (DPN) and aged-matched controls over short and long walking distances. The potential benefit of footwear for improving gait in patients with DPN was also explored.Methods:Twelve patients with DPN and eight controls walked at their habitual speed over short (7 m) and long (20 m) distances under two conditions: barefoot and regular shoes. A validated system of body-worn sensors was used to extract spatiotemporal gait parameters. Neuropathy severity was quantified using vibratory perception threshold measured at the great toe.Results:Gait deterioration in the DPN group was observed during all of the walking trials. However, the difference between patients with DPN and participants in the control group achieved statistical significance only during long walking distance trials. Shod and barefoot double support times were longer in the DPN group during long walking distances (>20%,P= .03). Gait ...