Footwear and Gait Stability in Diabetic Patients with Peripheral Neuropathy

NewsBot · May 22, 2013

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The Impact of Footwear and Walking Distance on Gait Stability in Diabetic Patients with Peripheral Neuropathy
Bijan Najafi, Tahir Khan, Adam Fleischer, and James Wrobel
JAPMA May/June 2013 vol. 103 no. 3 165-173

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 unsteadiness, defined as coefficient of variation of gait velocity, was also significantly higher in the DPN group when barefoot walking over long distances (83%, P = .008). Furthermore, there was a high correlation between neuropathy severity and gait unsteadiness best demonstrated during the barefoot walking/long walking distance condition (r = 0.77, P < .001). The addition of footwear improved gait steadiness in the DPN group by 46% (P = .02). All differences were independent of age, sex, and body mass index (P > .05).

Conclusions: This study suggests that gait alteration in patients with DPN is most pronounced while walking barefoot over longer distances and that footwear may improve gait steadiness in patients with DPN
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NewsBot · Oct 16, 2013

Diabetic Peripheral Neuropathy and Gait: Does Footwear Modify This Association?
Grewal GS, Bharara M, Menzies R, Talal TK, Armstrong D, Najafi B.
J Diabetes Sci Technol. 2013 Sep 1;7(5):1138-1146.

BACKGROUND:
Gait-related fall risk is the leading cause of mortality among patients with diabetes, especially those older than 65 years. Deterioration in balance and loss of protective sensation in lower extremities contribute significantly to fall risk in patients with diabetic peripheral neuropathy (DPN). This study aimed to explore the impact of neuropathy and foot ulcer on gait.
METHODS:
We recruited 39 participants (age, 56.9 ± 8.2 years; body mass index, 29.6.3 ± 4.7 kg/m2), including 15 DPN patients without foot ulcers, 16 DPN patients with foot ulcers, and 8 healthy aged-matched controls. Patients with active foot ulcers wore an offloading device during gait examination, including removable cast walker.
RESULTS:
Results suggest that neuropathy alters gait mainly by increasing gait initiation, gait variability (coefficient of variation of gait velocity), and double support (DS) time, while reducing knee range of motion and center of mass sway (p < .05). Interestingly, the presence of foot ulcer does not impact gait velocity (p > .1) but enhances some of the gait parameters such as gait variability and DS time.
CONCLUSIONS:
This study demonstrates that neuropathy deteriorates gait, but the presence of foot ulcers does not alter gait parameters further than neuropathy. In addition, patients with foot ulcers demonstrated a better gait compared with DPN patients without ulcers. We speculate that offloading footwear may be enhancing the somatosensory feedback from sensate skin, thereby positively affecting gait parameters. A study with a larger sample is required to explore the effect of prescribed footwear in the DPN population in order to validate the findings of this research study.
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NewsBot · Sep 17, 2023

Balance and gait in individuals with diabetic peripheral neuropathy
Süleyman Korkusuz et al
Neurol Res. 2023 Sep 15;1-9

Background: Diabetic Peripheral Neuropathy (DPN) causes various physical problems such as the increased risk of falling, loss of balance and coordination while standing or walking, susceptibility to injuries due to sensory loss.

Aims: The aim of the study was to evaluate and compare the effects of neuropathic pain (NP) in individuals with DPN on balance and gait.

Methods: This prospective controlled study was conducted on 42 adults aged between 40-65 years. The participants were divided into three groups; individuals with DPN and NP (DPN+NP/n = 14), individuals with DPN without NP (DPN-NP/n = 14), and the control group (n = 14), respectively. The Force Plate system and Core Balance System measured static and dynamic postural balance and stability limits. Gait and dynamic plantar pressure distribution analyses were performed with a computerized gait evaluation system.

Results: The score of LANSS, and VAS during gait were higher in DPN+NP group than in DPN-NP (p < 0.05). No significant difference was observed between the groups in balance parameters (p > 0.05). The right-left heel maximum forces were lower in both groups with DPN compared to the control group (p < 0.05). In terms of spatiotemporal parameters of the gait, there was a difference between the groups only in step width and left single support line parameters (p < 0.05).

Conclusions: The results of this study indicate that the individuals with DPN have an increased step width, their left single support line was shortened, and the maximum force on the heel decreased. The NP did not cause any change in balance and gait parameters.
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NewsBot · Feb 26, 2024

Impact of diabetic peripheral neuropathy on gait abnormalities in patients with type 2 diabetes mellitus
Samir H Assaad Khalil et al
Diabetol Int. 2023 Aug 16;15(1):58-66

Background: Many patients with type 2 diabetes (T2DM) suffer from diabetic peripheral neuropathy (DPN) and impaired muscle coordination. These changes may lead to walking instability, and gait abnormalities resulting in increased fall risk and lower limb amputations. The aim of this study was to assess the impact of DPN and patient footwear on the gait in patients with diabetes, in addition to Comparing the peak plantar pressure (PPP) in patients with and without DPN and assessing its association with gait abnormalities.

Methodology: This is an observational case-control study. Forty Subjects with T2DM were divided into two age and sex-matched groups, 20 subjects each. Group A: subjects with DPN. Group B: subjects without DPN. All study participants were subjected to a thorough history taking, clinical examinations focusing on detailed foot examination, PPP assessment, and functional gait evaluation.

Results: The results obtained in this study showed a median gait assessment score of 21 (17.0-22.5) for group A and 26 (23.5-26.0) for group B which was statistically significant (p < 0.001). There was no statistically significant difference between both groups (p > 0.05) regarding the assessment of footwear appropriateness. Comparing the PPP measurement among both studied groups, the prevalence of an elevated PPP was 80% in group A compared to 65% in group B, which was statistically non-significant, p = 0.288.

Conclusions: Gait abnormalities are common among patients with T2DM even in the absence of DPN. However, the presence of DPN was the strongest independent risk factor for gait abnormalities among the studied factors.
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NewsBot · Mar 24, 2024

Sensorimotor training improves gait, ankle joint proprioception, and quality of life in patients with diabetic peripheral neuropathy: A single-blinded randomized controlled trial
Marwa Shafiek Mustafa Saleh et al
Am J Phys Med Rehabil. 2024 Feb 29

Objective: To investigate the effect of Sensorimotor Training (SMT) on gait, ankle joint proprioception, and quality of life in Diabetic Peripheral Neuropathy (DPN) patients.

Design: A prospective, single-blind, randomized controlled experiment was performed. Forty patients with DPN aged 50 to 65 yrs were distributed randomly into two groups, the SMT group (n = 20) and the control group (n = 20). Both groups attended awareness sessions about diabetes and foot care for 30 minutes, every two weeks. Moreover, the SMT group received 6wk (3 days/week) of SMT. Spatiotemporal gait parameters, proprioception accuracy of the ankle joint, and quality of life were measured before and after 6 weeks of intervention.

Results: Regarding baseline data, no significant differences were identified among groups (p > 0.05). After 6wk intervention, the SMT group exhibited significant improvements in all outcome variables (p < 0.001), while the control group showed significant changes in quality of life only (p = 0.03). Comparing groups after intervention reveals statistically significant differences in all measured variables in favor of the SMT group (p < 0.001).

Conclusions: Sensorimotor training may improve spatiotemporal gait parameters, ankle joint proprioception, and quality of life of patients with DPN.
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