Gait abnormalities in diabetic neuropathy

OBJECTIVE - To investigate the effect of peripheral neuropathy on gait in diabetic patients. RESEARCH DESIGN AND METHODS - Gait analysis was performed in the following groups matched for age, sex, and BMI: 20 normal healthy control subjects (NC), 20 nonneuropathic diabetic control subjects (DC), 20 neuropathic diabetic subjects (DN), and 20 neuropathic diabetic subjects with a history of foot ulceration (DNU). All subjects with orthopedic foot problems were excluded from the study The following gait parameters were investigated: 1) walking speed; 2) stance phase duration; 3) joint angles and moment arms for the ankle. knee, and hip joints in both sagittal and frontal planes; 4) the components of the ground reaction force (GRF) vector; and 5) the ankle, knee, and hip joint moments originating from the GRF vector in both planes. RESULTS - There were no statistical differences in any of the parameters studied between the NC and DC groups. Walking speed was significantly slower in the DNU group compared with the two control groups (P < 0.02). The maximum knee joint angle was smaller in the sagittal plane for the DNU group compared with the DC group values (P < 0.05). The maximum value of the vertical component of GRF was found to be higher (P < 0.03) in the two control groups compared with the DNU group. The maximum value of the anteroposterior forces was also found to be higher (P < 0.001) in the DC group compared with the DNU group. The maximum frontal plane ankle joint moment was significantly higher (P < 0.05) in the DN compared with the NC group. CONCLUSIONS - Diabetic subjects with peripheral neuropathy demonstrate alterations in some gait parameters during walking. These alterations could facilitate fool injuries, thus contributing to frequent foot ulceration.