Differences in the Gait Characteristics of Patients With Diabetes and Peripheral Neuropathy Compared With Age-Matched Controls

Mueller, Michael J.; Minor, Scott D; Sahrmann, Shirley A.; Schaaf, James A; Strube, Michael

doi:10.1093/ptj/74.4.299

Cited by 294 publications

(257 citation statements)

References 24 publications

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“…Clinical measures of passive ankle DF ROM and stiffness obtained in this study are consistent with previous reports documenting reduced ankle DF ROM [10,26] and increased stiffness [22] in subjects with DM. Changes in ankle DF ROM and stiffness in individuals with DM have been attributed to disease-dependent as well as use-dependent processes.…”

Section: Discussionsupporting

confidence: 91%

“…Disease-dependent mechanisms involve non-enzymatic glycation of collagen due to the underlying metabolic disorder [11]. Use-dependent mechanisms allude to adaptive fiber shortening within the triceps surae [29]. Qualitative changes in connective tissue stiffness as well as quantitative changes related to changes in the ratio of connective tissue to contractile tissue may contribute to increased ankle stiffness in individuals with DM.…”

Section: Discussionmentioning

confidence: 99%

“…Since almost all walking is performed in shoewear, we thought the continuance of this practice in our study best reflected real life situation and would confer external validity to the study. Previous studies have documented walking velocities between 0.77 and 1.26 m/s in subjects with DM [12,26,27], therefore 0.89 m/s (2 mph) was chosen as a comfortable walking speed, representative of preferred walking speed in subjects with DM. Walking speed was controlled in this study because the self-selected walking speeds in subjects with DM and neuropathy are typically significantly slower than non-diabetic controls [12,28,29].…”

Section: Gait Testingmentioning

confidence: 99%

“…Previous studies have documented walking velocities between 0.77 and 1.26 m/s in subjects with DM [12,26,27], therefore 0.89 m/s (2 mph) was chosen as a comfortable walking speed, representative of preferred walking speed in subjects with DM. Walking speed was controlled in this study because the self-selected walking speeds in subjects with DM and neuropathy are typically significantly slower than non-diabetic controls [12,28,29]. Walking speed influences ankle kinematics and kinetics [14,15] and also differentially affects plantar pressures in different regions of the foot [16][17][18].…”

Section: Gait Testingmentioning

confidence: 99%

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Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy

2006

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Introduction-The purpose of our study was to examine the relationship between ankle dorsiflexion (DF) range of motion (ROM) and stiffness measured at rest (passively) and plantar loading during gait in individuals with and without diabetes mellitus (DM) and sensory neuropathy. Specifically, we sought to address three questions for this at-risk patient population: (1) Does peak passive DF ROM predict ankle DF ROM used during gait? (2) Does passive ankle stiffness predict ankle stiffness used during gait? (3) Are any of the passive or gait-related ankle measures associated with plantar loading?Methods-Ten subjects with DM and 10 age and gender matched non-diabetic control subjects participated in this study. Passive ankle DF ROM and stiffness were measured with the Iowa Ankle ROM device. Kinematic, kinetic and plantar pressure data were collected as subjects walked at 0.89 m/s.Results-We found that subjects with DM have reduced passive ankle DF ROM and increased stiffness compared to non-diabetic control subjects, however, subjects with DM demonstrated ankle motion, stiffness and plantar pressures, similar to control subjects, while walking at the identical speed, 0.89 m/s (2 mph). These data indicate that clinical measures of heel cord tightness and stiffness do not represent ankle motion or stiffness utilized during gait. Our findings suggest that subjects with DM utilize strategies such as shortening their stride length and reducing their push-off power to modulate plantar loading.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Gait Testingmentioning

confidence: 99%

Section: Gait Testingmentioning

confidence: 99%

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Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy

2006

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“…Based on a number of gait parameters reported by Mueller et al [23] a range was found for the standardised difference of between 1.15 and 1.57. For this power calculation a conservative estimate of the standard difference of 1 was used.…”

Section: Discussionmentioning

confidence: 99%

Walking performance in people with diabetic neuropathy: benefits and threats

et al. 2006

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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.

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Gait and Exercise Training in Diabetic Peripheral Neuropathy

Reeves

2020

The Foot in Diabetes

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Differences in the Gait Characteristics of Patients With Diabetes and Peripheral Neuropathy Compared With Age-Matched Controls

Cited by 294 publications

References 24 publications

Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy

Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy

Walking performance in people with diabetic neuropathy: benefits and threats

Gait and Exercise Training in Diabetic Peripheral Neuropathy

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