Plantar Sensation and Balance in Patients with Type 2 Diabetes Mellitus with and without Peripheral Neuropathy

Yümin, Eylem Tütün; Şimşek, Tülay Tarsuslu; Bakar, Yeşim

doi:10.20471/acc.2021.60.02.04

Cited by 5 publications

(7 citation statements)

References 35 publications

(53 reference statements)

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“…7 Type 2 DM can cause changes in the central nervous system, neuropathy, and loss of sensation in the foot, leading to gait abnormalities and abnormal tissue loading. 5 , 12 , 18 Symptoms of type 2 DM include ulcerations of the plantar foot, with forefoot ulcerations being the most common. 6 , 15 There is a 15% to 25% risk of developing a diabetic foot ulcer (DFU) in the lifetime of a person with type 2 DM, with neuropathy increasing this 4 times.…”

Section: Introductionmentioning

confidence: 99%

Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus

Gwaltney,

Harrington,

Anguiano-Hernandez

et al. 2024

Foot & Ankle Orthopaedics

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Background: Diabetic patients with foot ulcers are commonly prescribed assistive walking devices to unload the affected foot and promote tissue healing. However, the effect on shear loads to the contralateral foot is unknown. This study investigated the effect of a wheeled knee walker (WKW), compared to common devices, on compressive and shear plantar forces carried by the propulsive foot during walking in patients with type 2 diabetes mellitus. A secondary objective investigated plantar forces’ correlations with body weight unloaded (BWU). Methods: Participants walked a maximum of 200 m per condition during normal walking or when using crutches, a standard walker, and a WKW in randomized order. Plantar forces were measured with force plates, and wireless force-sensitive pads measured BWU through the hands. The WKW was instrumented to measure BWU onto the seat and handlebars. Three-dimensional motion capture confirmed gait events. Results: The WKW produced the lowest vertical, braking, propulsive, and medial shear forces but the highest lateral shear force among all conditions. Using crutches or a walker had negligible medial and lateral shear (mean = −6.69 N and −7.80 N), with normal walking producing the highest medial shear. There was a poor relationship between BWU and assistive walking devices and shear force values. Conclusion: A WKW could be the preferred assistive device for unloading a diabetic foot ulcer. The magnitude of lateral force would need further investigation to determine ulceration risk, given patient susceptibility and neuropathy. Clinical Relevance: Understanding shear forces on the propulsive foot is important for minimizing contralateral limb tissue damage risk while treating an ulcer. Different assistive walking devices change walking patterns and affect shear forces on the plantar surface of the foot. Although the WKW minimizes several loading metrics, a clinical trial investigating assistive walking device compliance and wound healing in diabetic foot ulcer patients across devices is needed.

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Section: Introductionmentioning

confidence: 99%

Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus

Gwaltney,

Harrington,

Anguiano-Hernandez

et al. 2024

Foot & Ankle Orthopaedics

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“…15 For this purpose, the Pin-Prick test was used to assess nociception (superficial sensitivity pathway) 16,17 and the deep sensitivity pathway 17 was assessed by exploring the vibration sensation using a 128-Hz Rydel-Seiffer diapason and biothesiometer 18 and light touch-pressure using a Semmes-Weinstein monofilament (SWMT). 14,19 Many studies have confirmed that reduced sensitivity in lower limbs is related to postural and gait disorders, [20][21][22][23][24] but few have studied the correlations between different alterations of sensory modalities and gait parameters. Changes in plantar sensitivity and tactile and vibratory sensitivity in lower limbs have been seen to alter human gait.…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have confirmed that reduced sensitivity in lower limbs is related to postural and gait disorders, 20‐24 but few have studied the correlations between different alterations of sensory modalities and gait parameters. Changes in plantar sensitivity and tactile and vibratory sensitivity in lower limbs have been seen to alter human gait 9 .…”

Section: Introductionmentioning

confidence: 99%

Relationship between deep and superficial sensitivity assessments and gait analysis in diabetic foot patients

Sempere-Bigorra

Brognara

Julián-Rochina

et al. 2023

International Wound Journal

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Peripheral neuropathy is a prevalent complication of diabetes that can lead to gait impairment and its adverse consequences. This study explored the potential utility of different parameters of gait analysis using a single sensor unit as a simple tool to detect peripheral neuropathy in 85 diabetic patients (DP) with diabetic foot in whom different somato‐sensitivity tests in the feet were performed. Gait spatiotemporal parameters were examined by sensor inertial measurement placed in the lumbar area, while the superficial sensitivity pathway was assessed by nociception tests and deep sensitivity was examined by light touch‐pressure and vibration sensitivity tests. Correlations between each sensory test and gait parameters were analysed in a logistic regression model in order to assess if gait parameters are associated with two different sensory pathways. Impaired deep sensory pathways were significantly (P < .05) correlated with lower gait speed, reduced cadence, smaller stride length, longer stance periods, and a higher risk of falling on the Tinetti Scale, while all gait parameters were significantly (P < .01) correlated with the superficial sensory pathway. Type 2 diabetics have significantly (P < .05) higher impairment in vibratory sensitivity than type 1 diabetics, and the years with diabetes mellitus (DM) diagnosis have a significant (P < .05) association with reduced vibration sensitivity. These findings indicate relationships between the deep sensory pathway and gait impairments in DP measured by inertial sensors, which could be a useful tool to diagnose gait alterations in DP and to evaluate the effect of treatments to improve gait and thus the risk of falls in diabetic patients.

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“…The maintenance of functional balance relies on the central integration of afferent information from visual, vestibular and somatosensory systems [24]. In people with diabetes and neuropathy, the loss of cutaneous sensory receptors in the plantar surface of the foot [25] and LJMS [26] seem to be associated with altered awareness of lower limb positioning and functional restriction at the ankle, leading to reduced postural stability. When people with diabetes and neuropathy detect postural instability, they tend to adopt a more rigid posture involving muscle co‐contraction to aid stability [27].…”

Section: Introductionmentioning

confidence: 99%

Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof‐of‐concept RCT

Lepesis,

Paton,

Rickard

et al. 2023

Journal of Foot and Ankle Research

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Introduction People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs. Design and methods Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1st MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance. Results At T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%). Conclusions Combining ankle and 1st MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk. Trial registration https://classic.clinicaltrials.gov/ct2/show/NCT03195855.

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Plantar Sensation and Balance in Patients with Type 2 Diabetes Mellitus with and without Peripheral Neuropathy

Cited by 5 publications

References 35 publications

Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus

Plantar Kinetics During Wheeled Knee Walker Use Compared to Different Assistive Walking Devices in Persons With Type 2 Diabetes Mellitus

Relationship between deep and superficial sensitivity assessments and gait analysis in diabetic foot patients

Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof‐of‐concept RCT

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