The Impact of Footwear and Walking Distance on Gait Stability in Diabetic Patients with Peripheral Neuropathy

Najafi, Bijan; Khan, Tahir; Fleischer, Adam E.; Wrobel, James S.

doi:10.7547/1030165

Cited by 31 publications

(46 citation statements)

References 46 publications

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“…Previous studies have demonstrated that peripheral neuropathy and fear of falling are linked to changes in gait performance, 4,26,31–34 and the present findings are in good agreement with these. Patients with DPN, for example, are known to adopt a conservative walking strategy, with a longer double-support phase and generally slower stride velocities compared with patients without DPN.…”

Section: Discussionsupporting

confidence: 93%

“…Moreover, these findings suggest that there is an apparent mismatch between perceived risk of falling and actual risk of falling in older adults with diabetes mellitus. This is important because gait performance declines with DPN 26,27 and places individuals with DPN at greater risk for fall events. 28–30 However, our work suggests, worsening gait performance is not always accompanied by a greater fear of falling.…”

Section: Discussionmentioning

confidence: 99%

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Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

Kelly

Fleischer

Yalla

et al. 2013

Journal of the American Podiatric Medical Association

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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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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

Kelly

Fleischer

Yalla

et al. 2013

Journal of the American Podiatric Medical Association

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“…With a custom-made foot plate, gauntlet styling enabling plantar and dorsi flexion of the foot, the AFO might have improved proprioception (Hijmans et al, 2007) due to increased skin contact at the plantar aspect of the foot (Najafi et al, 2013b) as well as the shin area (Feuerbach et al, 1994) in contrast to the standard shoes.…”

Section: Discussionmentioning

confidence: 98%

An immediate effect of custom-made ankle foot orthoses on postural stability in older adults

Yalla

Crews

Fleischer

et al. 2014

Clinical Biomechanics

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“…One potential explanation could be the DFO's contoured arch could have contributed to improved gait parameters. 16 Our prior work demonstrated that custom foot orthoses reduced gait variability and medial and lateral COM displacement 16 that may be the result of improved proprioceptive feedback. 16,25 The custom foot orthoses tested in these studies used top covers that were glued to the underlying contoured shell and they did not allow freedom movement within top cover layers as the DFO in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…There was a 5-minute acclimatization period without weight-bearing, shoes, or socks prior to baseline thermal imaging and standardized walking stress test. 15 In random sequence, each insole condition was tested for gait during habitual speed, 16 balance in tandem stance with eyes open and closed, 17 and a thermal image was taken after 200 steps of walking stress. To explore whether reducing shear force may impact risk of falling, gait was also examined during dual task (walking while counting backward), which is a more sensitive paradigm than single task (walking alone) to evaluate risk of falling.…”

Section: Methodsmentioning

confidence: 99%

A Novel Shear Reduction Insole Effect on the Thermal Response to Walking Stress, Balance, and Gait

Wrobel

Peethambaran

et al. 2014

J Diabetes Sci Technol

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Reducing shear or side-to-side stresses on the plantar surfaces of feet in patients with diabetes is of particular interest lately. Conflicting clinical trial data of custom pressure-reducing footwear suggest that other offloading or footwear approaches may be necessary. 1,2 Gait lab studies suggest shear stresses are in a different location and magnitude versus age-matched controls. 3 Shear stresses in the foot also demonstrate a large association with thermal changes in response to walking in patients with diabetes and peripheral neuropathy. 4 Currently, there are no commercially available products to detect shear inside the shoe. However, relative temperature changes using thermometry may represent antecedent inflammatory changes from shear and pressure occurring prior to clinical expression of foot ulceration at the skin level. Purposeful "cooling" of the foot in clinical trials resulted in effect sizes of 4-to 10-fold reduction in reulceration. 5-7 Autonomic neuropathy can also affect thermoregulation of foot temperature and may be a more sensitive measure 8 for predicting foot ulcer. 9 In this study we measured sudomotor function for small fiber autonomic neuropathy. 10-12 Shear-reducing insoles that permit side-to-side motion in the device to reduce shear at the skin and deeper tissue level may make patients feel unsteady and less confident with walking. Therefore, in this study, we measured gait and balance changes under single and dual task conditions to explore for gait adaptations. In addition, these measurements may 546528D STXXX10.

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The Impact of Footwear and Walking Distance on Gait Stability in Diabetic Patients with Peripheral Neuropathy

Abstract: 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.

Cited by 31 publications

References 46 publications

Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

An immediate effect of custom-made ankle foot orthoses on postural stability in older adults

A Novel Shear Reduction Insole Effect on the Thermal Response to Walking Stress, Balance, and Gait

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