Gait abnormalities found in diabetic neuropathy

By Joanna Lyford, Senior medwireNews Reporter

Ankle muscle strength and joint mobility are the key factors influencing gait abnormalities in people with diabetic peripheral neuropathy (DPN), Brazilian research suggests.

The findings could allow for the development of preventive strategies, Alessandra Martinelli (School of Science and Technology, Presidente Prudente) and colleagues write in TheFoot.

The researchers studied 25 patients with Type 2 diabetes and peripheral neuropathy and 27 healthy people matched for age and gender. The diabetes patients all scored at least 8 on the Michigan Neuropathy Screening Instrument.

All the participants were assessed for gait spatio-temporal parameters using an electronic baropodometry treadmill and for ankle muscle strength using a dynamometer.

Gait analysis revealed several abnormalities in patients with diabetic peripheral neuropathy. Specifically, diabetic patients had a shorter stride length (1.04 vs 1.14 m), slower cycle speed (0.89 vs 1.03 m/s), and longer duration of total support (0.77 vs 0.70 s) compared with controls.

In addition, neurologically impaired participants had smaller ankle dorsiflexion mobility and increased plantarflexion mobility, along with reduced muscle strength of both dorsiflexors and plantiflexors.

Correlation analysis identified a significant positive relationship between plantiflexor muscle strength and the length and speed of the gait cycle. Also, gait performance was predicted by the muscle strength of the plantiflexors and dorsiflexors and the range of motion of dorsiflexion.

Taken together, these results support the hypothesis that patients with diabetic neuropathy have alterations in gait pattern and muscle strength, say Martinelli et al.

They say that several factors could be responsible for the reduced muscle strength in diabetic individuals, such as intrinsic abnormalities in diabetic muscle, impaired capillary recruitment, peripheral arterial disease, and diabetic polyneuropathy. The changes in muscle activity may in turn lead to the observed increase in plantarflexion motion.

The authors conclude: "These impairments are important contributors of walking limitations related to diabetic peripheral neuropathy. Clinical importance should be given to rehabilitation and maintenance of the functionality of the ankle complex, in order to maintain greater mobility and muscle strength of the ankle for a better gait performance."

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