Evaluation of Ankle Joint Position Sense in Patients with Type 2 Diabetes Mellitus with Peripheral Neuropathy by Isokinetic Dynamometer

Background: Proprioceptive disorders may occur when thick fibers are affected in diabetic neuropathy. This can lead to impaired joint stabilization and increased risk of falls and fractures. We evaluated joint position sense (JPS) in diabetic patients to detect those at risk for neuropathy earlier. Methods: Sixty diabetic patients and 30 healthy individuals aged 30 to 60 years were included in the study and divided into three groups: 30 diabetic patients with peripheral neuropathy, 30 diabetic patients without peripheral neuropathy, and 30 nondiabetic control patients. Presence of neuropathy was determined electrophysiologically. Passive ankle JPS was evaluated by an isokinetic system in all three groups. Both 10 degrees and 30 degrees plantarflexion and 10 degrees dorsiflexion were determined as target angles. The mean absolute angular error (MAAE) values for three trials with each angle were assessed by Kruskal-Wallis and Mann-Whitney U tests. Results: The MAAEs with all of the angles were significantly higher in diabetic patients with peripheral neuropathy compared with diabetic patients without peripheral neuropathy and the control group (P < .001 for all of the comparisons). The MAAEs with right ankle 10 degrees plantarflexion (P = .004) and 10 degrees dorsiflexion (P = .007) and left ankle 10 degrees plantarflexion (P = .008) were significantly higher in diabetic patients without peripheral neuropathy than in the control group. Conclusions: According to these results, ankle JPS may be deteriorated before determination of neuropathy electrophysiologically. Therefore, we believe that prophylactic programs in terms of the risk of falls and fractures by evaluating JPS need to be developed in the early stages of diabetes.