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Differences in the Gait Characteristics of Patients With Diabetes and Peripheral Neuropathy Compared With Age-Matched Controls

MJ Mueller, PhD, PT, is Assistant Professor, Program in Physical Therapy, Washington University School of Medicine, 660 S Euclid, Box 8083, St Louis, MO 63110 (USA).
SD Minor, PhD, PT, is Assistant Professor, Program in Physical Therapy, Washington University School of Medicine.
SA Sahrmann, PhD, PT, FAPTA, is Associate Professor, Program in Physical Therapy, Washington University School of Medicine.
JA Schaaf, PhD, is Visiting Research Associate and Lecturer, Department of Mechanical and Aeronautical Engineering, University of California, Davis, CA 95616. He was Hunter Assistant Professor of Mechanical Design, Mechanical Engineering, Washington University, at the time of this study.
MJ Strube, PhD, is Professor of Psychology, Washington University.
This study was completed in partial fulfillment of the requirements for Dr Mueller's doctoral degree in the Interdisciplinary Program in Movement Science, Washington University School of Medicine.

Background and Purpose. Patients with diabetes and peripheral neuropathy have a high incidence of injuries while walking. Biomechanical analysis of their walking may lead to treatments to reduce these injuries. The purpose of this study was to compare (1) the gait characteristics, (2) the plantar-flexor peak torques, and (3) the ankle range of motion of subjects with diabetes mellitus (DM) and peripheral neuropathy with those of age-matched controls. Subjects. Twenty subjects, 10 with DM and a history of peripheral neuropathy (DM group) (mean age=58 years, SD=15, range=35–75) and 10 subjects without diabetes (NODM group) (mean age=57 years, SD=11, range=37–68), were evaluated. Methods. The following data were collected on all subjects: ankle joint mobility, plantar-flexor peak torque (ankle strength), kinematics of the trunk and lower extremity during normal walking, and ground reaction forces. Moments and power at the ankle, knee, and hip during walking were calculated using a two-dimensional link-segment model. Results. The DM group subjects showed less ankle mobility, ankle moment, ankle power, velocity, and stride length during walking than the NODM group subjects. A significant decrease in ankle strength and mobility appeared to be the primary factor contributing to the altered walking patterns of the DM groups. Conclusion and Discussion. The DM group subjects appeared to pull their legs forward using hip flexor muscles (hip strategy) rather than pushing the legs forward using plantar-flexor muscles (ankle strategy), as seen in the NODM group subjects. Implications for treatment are presented to attempt to reduce the number of injuries during walking in patients with DM and peripheral neuropathy.

Key Words: Biomechanics • Diabetes mellitus • Gait analysis • Joint mobility • Kinetics • Muscle performance

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