A Preliminary Study of Gait in Elderly Women with Diabetic Peripheral Neuropathy

Somatosensory impairment due to diabetic peripheral neuropathy results in decreased environmental input during ambulation, which may compromise feedback mechanisms used for balance control Individuals with distal symmetrical diabetic peripheral neuropathy provide a model of somatosensory loss in which balance impairments can be studied. Somatosensory input is an important component of standing balance in the elderly. Diabetic peripheral neuropathy has been associated with postural instability and an increased history of falls. This study investigated differences in gait between elderly diabetic subjects with distal symmetrical sensory polyneuropathy and elderly diabetics without neuropathy. To conduct this study the 3-dimensional gait analysis protocol developed at the Center for Human Kinetic Studies (CHKS) was used. In this preliminary study, differences in gait were identified which may reflect a more cautious walking strategy in diabetics with peripheral neuropathy. In stance, subjects with peripheral neuropathy demonstrated an applied extension biased hip torque, decreased hip flexion and decreased pelvic tilt, as compared to non-neuropathic subjects. This distinct hip strategy could reduce forward momentum of the head, arms, and trunk and reduce dynamic balance demands during walking. Total limb support moments during stance in neuropathic subjects were approximately one half as great as those observed for controls. Additionally, neuropathic subjects demonstrated less braking shear force during initial contact and early loading response, with a concomitant increase in horizontal anterior heel velocity, suggesting a slight time lag in weight transfer