Balance and diabetic neuropathy

NewsBot · Jul 23, 2008

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Investigation of standing balance in patients with diabetic neuropathy at different stages of foot complications.
Kanade RV, Van Deursen RW, Harding KG, Price PE.
Clin Biomech (Bristol, Avon). 2008 Jul 19. [Epub ahead of print]

BACKGROUND: Diabetic peripheral neuropathy is known to cause postural instability. This study investigated standing balance in patients with diabetic neuropathy with secondary foot complications: foot ulceration, partial foot amputation and trans-tibial amputation, which are expected to pose further challenge to balance control.

METHODS: In this cross-sectional study, 23 patients with diabetic neuropathy alone (controls) were compared with 23 patients with diabetic foot ulceration, 16 patients with partial foot amputation and 22 patients with trans-tibial amputation. Posturography was used to determine the centre of pressure excursion during quiet standing. Differences between the 4 groups were tested using ANOVA and post-hoc comparisons.

FINDINGS: The 4 groups varied in neuropathy score (P=0.001) and demonstrated significant decline in balance from neuropathy alone to foot ulceration, to partial foot amputation and trans-tibial amputation based on total excursion of centre of pressure (P<0.001) and centre of pressure excursion in antero-posterior direction (P<0.001). The excursion of centre of pressure in medio-lateral direction varied between 4 groups (P<0.05) however, there was no significant trend. The distance between ankles increased significantly from neuropathy to trans-tibial amputee group (P=0.001). Post-hoc comparison with controls revealed that each of three study groups demonstrated decreased balance (diabetic neuropathy vs. foot ulceration, P=0.001, diabetic neuropathy vs. partial foot amputation, P=0.002 and diabetic neuropathy vs. trans-tibial amputation, P=0.009).

INTERPRETATION: Balance deterioration among patient groups from diabetic neuropathy alone to trans-tibial amputation appears to result from bio-mechanical impairment caused by progression of foot complications in addition to postural instability caused by diabetic neuropathy.
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Admin2 · Jul 25, 2008

Related:
Other falls threads
Other postural stability threads
Other diabetic neuropathy threads

NewsBot · Dec 2, 2013

Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy
Carolyn Kelly, Adam Fleischer, Sai Yalla, Gurtej S. Grewal, Rachel Albright, Dana Berns, Ryan Crews, Bijan Najafi
J Am Podiatr Med Assoc 103(6): 480–488, 2013

Background: Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling.

Methods: A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe.

Results: Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = −0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant’s actual concern about falling.

Conclusions: Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy.
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NewsBot · Sep 11, 2014

The effect of feet position on standing balance in patients with diabetes.
Mehdikhani M, Khalaj N, Chung TY, Mazlan M.
Proc Inst Mech Eng H. 2014 Aug;228(8):819-23.

Feet displacement is recognized to be an important element in standing and is also linked to postural instability in elderly people with diabetes. This study investigates standing balance in diabetic patients in four asymmetric feet displacements. Quiet standing balance was investigated using the Biodex Balance System in 18 diabetic patients and compared with 18 control elderly subjects. The four standing conditions, namely, comfortable feet position, preferred feet position with a stance width of 17 cm and 15° angle between the medial borders, feet side by side, and heel side by side with a 30° angle between medial edges of feet were evaluated (i.e. eyes opened, eyes closed). The overall stability was calculated by measuring anterior-posterior and medial-lateral indices in standing conditions. Differences among feet positions were compared using an analysis of variance and the independent t-test. The diabetic patients were unstable in the medial-lateral direction when standing with feet side by side versus heel side by side with a 30° angle between medial edges of feet (p = 0.012 and 0.011, respectively), while in controls the anterior-posterior stability scores between standing in preferred foot position with stance width of 17 cm and 15° angle between the medial borders versus feet side by side, and heel side by side with a 30° angle between medial edges of feet versus preferred foot position with stance width of 17 cm and 15° angle between the medial borders had significant difference (p < 0.05). The anterior-posterior stability scores of diabetic subjects with feet side by side versus comfortable foot position (p = 0.047) and heel side by side with a 30° angle between medial edges of feet versus comfortable foot position (p = 0.016) when they closed their eyes during the test had significant difference. Results confirmed that diabetic patients have greater instability in the medial-lateral direction when the base of support reduces and visual clue has an important role in standing balance.
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NewsBot · Oct 7, 2014

Hip strength: ankle proprioceptive threshold ratio predicts falls and injury in diabetic neuropathy.
Richardson JK1, Demott T, Allet L, Kim H, Ashton-Miller JA.
Muscle Nerve. 2014 Sep;50(3):437-42.

INTRODUCTION:
We determined lower limb neuromuscular capacities associated with falls and fall-related injuries in older people with declining peripheral nerve function.
METHODS:
Thirty-two subjects (67.4 ± 13.4 years; 19 with type 2 diabetes), representing a spectrum of peripheral neurologic function, were evaluated with frontal plane proprioceptive thresholds at the ankle, frontal plane motor function at the ankle and hip, and prospective follow-up for 1 year.
RESULTS:
Falls and fall-related injuries were reported by 20 (62.5%) and 14 (43.8%) subjects, respectively. The ratio of hip adductor rate of torque development to ankle proprioceptive threshold (Hip(STR) /AnkPRO ) predicted falls (pseudo-R(2) = .726) and injury (pseudo-R(2) = .382). No other variable maintained significance in the presence of Hip(STR) /AnkPRO .
CONCLUSIONS:
Fall and injury risk in the population studied is related inversely to Hip(STR) /AnkPRO . Increasing rapidly available hip strength in patients with neuropathic ankle sensory impairment may decrease risk of falls and related injuries.
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