Diabetic Neuropathy and Gait: A Review
This review focused on kinetics, kinematics and posture during gait in patients with diabetic peripheral neuropathy (DPN).
The authors identified an intimate link between DPN and abnormalities in gait, and demonstrated an increased risk in falls for older patients with diabetes.
DPN is a symmetrical sensorimotor polyneuropathy which is associated with metabolic and microvessel changes due to hyperglycaemia and concomitant cardiovascular risk covariates.
The prevalence of DPN is thought to be around 50% and increases with a longer duration of the disease and poor glycaemic control.
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Numerous abnormalities, including sensory loss (impaired vibration and protective sensation), decreased lower extremity strength (force-producing capacity) and alterations in the central nervous system contribute to impaired gait in diabetes.
People with diabetic neuropathy are at far greater risk of falling than those with intact sensation.
Reduced walking speed, cadence and step length and fewer acceleration patterns have been noted in subjects with diabetic neuropathy.
The range of movement at joints is altered in diabetes, and patients with DPN have a reduced motion at the ankle in dorsiflexion and plantar flexion and a reduced range of motion at the knee in both flexion and extension compared to non-diabetic individuals.
Ground reaction forces seem to differ between patients with DPN, without DPN and controls at either the initial contact or toe-off stage of gait.
Muscular atrophy is thought to underlie motor weakness at the ankle in patients with DPN.
Atrophy of the small muscles in the foot, leads to a loss of support surface and an increase in bony prominences.
These changes are thought to result in higher peak plantar pressures at the mid-foot and forefoot when compared to patients with and without DPN.
Further detailed evaluation of gait disorders in DPN is required, particularly in terms of accurately phenotyping neuropathy in relation to gait disorders.
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References:
- Alam, U., Riley, D. R., Jugdey, R. S., Azmi, S., Rajbhandari, S., D’Août, K., Malik, R. A. (2017) Diabetic Neuropathy and Gait: A Review. Diabetes Ther: 2017, Vol. 8, pp. 1253-1264.
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