Diabetic Gait Is Not Just Slow Gait: Gait Compensations in Diabetic Neuropathy.
Journal
Journal of diabetes research
ISSN: 2314-6753
Titre abrégé: J Diabetes Res
Pays: England
ID NLM: 101605237
Informations de publication
Date de publication:
2019
2019
Historique:
received:
09
07
2019
accepted:
05
09
2019
entrez:
10
12
2019
pubmed:
10
12
2019
medline:
11
6
2020
Statut:
epublish
Résumé
Neuropathic complications from diabetes mellitus affect multiple nerve types and may manifest in gait. However, gait compensations are still poorly understood, as narrow analyses and lack of speed controls have contributed to conflicting or equivocal results. To evaluate gait mechanics and energetics in diabetic peripheral polyneuropathy. Instrumented gait analysis was performed on 14 participants with diabetic peripheral polyneuropathy and 14 matched controls, walking at 1.0 m/s. A full-body model with a multisegment foot was used to calculate inverse dynamics and analyze sagittal plane metrics and time series waveforms across stance phase. Alterations included increased hip and knee flexion in early stance followed by a prolonged hip extension moment in midstance. Late stance ankle dorsiflexion and power absorption were increased, and final push-off was delayed and truncated. A neuropathic diabetic gait shares important similarities to a mild crouch gait with weakness/dysfunction in the foot and ankle. This study highlights two main compensation mechanisms that have been overlooked in previous literature. First, increased triceps surae stretch in terminal stance may be used to increase proprioception and/or energy storage, while a prolonged hip extension moment in midstance compensates for a limited push-off. These result in an overall workload shift from distal to proximal joints. Clinical assessment, monitoring, and treatment of neuropathy may benefit by focusing on these specific functional alterations.
Sections du résumé
BACKGROUND
BACKGROUND
Neuropathic complications from diabetes mellitus affect multiple nerve types and may manifest in gait. However, gait compensations are still poorly understood, as narrow analyses and lack of speed controls have contributed to conflicting or equivocal results.
PURPOSE
OBJECTIVE
To evaluate gait mechanics and energetics in diabetic peripheral polyneuropathy.
METHODS
METHODS
Instrumented gait analysis was performed on 14 participants with diabetic peripheral polyneuropathy and 14 matched controls, walking at 1.0 m/s. A full-body model with a multisegment foot was used to calculate inverse dynamics and analyze sagittal plane metrics and time series waveforms across stance phase.
RESULTS
RESULTS
Alterations included increased hip and knee flexion in early stance followed by a prolonged hip extension moment in midstance. Late stance ankle dorsiflexion and power absorption were increased, and final push-off was delayed and truncated.
CONCLUSION
CONCLUSIONS
A neuropathic diabetic gait shares important similarities to a mild crouch gait with weakness/dysfunction in the foot and ankle. This study highlights two main compensation mechanisms that have been overlooked in previous literature. First, increased triceps surae stretch in terminal stance may be used to increase proprioception and/or energy storage, while a prolonged hip extension moment in midstance compensates for a limited push-off. These result in an overall workload shift from distal to proximal joints. Clinical assessment, monitoring, and treatment of neuropathy may benefit by focusing on these specific functional alterations.
Identifiants
pubmed: 31815148
doi: 10.1155/2019/4512501
pmc: PMC6878800
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4512501Informations de copyright
Copyright © 2019 Adrienne D. Henderson et al.
Déclaration de conflit d'intérêts
There were no conflicts of interest.
Références
Clin Biomech (Bristol, Avon). 2013 Oct;28(8):831-45
pubmed: 24035444
Gait Posture. 2001 Jul;14(1):1-10
pubmed: 11378419
Diabetes Care. 2002 Jun;25(6):1066-71
pubmed: 12032116
Arch Phys Med Rehabil. 1996 Sep;77(9):849-55
pubmed: 8822673
Gait Posture. 2004 Apr;19(2):194-205
pubmed: 15013508
Diabetes. 2004 Jun;53(6):1543-8
pubmed: 15161759
Gait Posture. 2017 Oct;58:208-213
pubmed: 28806708
Skeletal Radiol. 2017 Dec;46(12):1643-1655
pubmed: 28765991
J Appl Physiol (1985). 2005 Aug;99(2):603-8
pubmed: 15845776
Ann Fam Med. 2009 Nov-Dec;7(6):555-8
pubmed: 19901316
Clinics (Sao Paulo). 2009;64(2):113-20
pubmed: 19219316
Gait Posture. 2012 Jan;35(1):101-5
pubmed: 22098824
J Pediatr Orthop. 2002 Sep-Oct;22(5):677-82
pubmed: 12198474
Diabetes Metab Res Rev. 2008 Mar-Apr;24(3):173-91
pubmed: 18232063
Diabet Med. 2005 Dec;22(12):1713-9
pubmed: 16401317
J Diabetes Sci Technol. 2010 Jul 01;4(4):833-45
pubmed: 20663446
Clin Neurol Neurosurg. 2006 Jul;108(5):477-81
pubmed: 16150538
Gait Posture. 2018 May;62:111-116
pubmed: 29544155
J Biomech. 2014 Aug 22;47(11):2745-50
pubmed: 24935172
J Biomech. 2010 Aug 10;43(11):2099-105
pubmed: 20493489
J Pediatr Orthop. 1993 Nov-Dec;13(6):722-6
pubmed: 8245195
Endocr Rev. 2008 Jun;29(4):494-511
pubmed: 18436709
Gait Posture. 2015 Oct;42(4):435-41
pubmed: 26253996
Clin Biomech (Bristol, Avon). 2009 Oct;24(8):687-92
pubmed: 19497649
BMC Musculoskelet Disord. 2009 Feb 03;10:16
pubmed: 19192272
Diabetologia. 2009 Jun;52(6):1182-91
pubmed: 19280173
J Biomech. 2018 Jun 25;75:1-12
pubmed: 29724536
J Biomech. 2015 Oct 15;48(13):3679-84
pubmed: 26338099
Muscle Nerve. 2011 Aug;44(2):258-68
pubmed: 21755508
Phys Ther. 1994 Apr;74(4):299-308; discussion 309-13
pubmed: 8140143
PLoS One. 2016 Apr 27;11(4):e0154654
pubmed: 27119372
Eura Medicophys. 2006 Jun;42(2):127-33
pubmed: 16767059
Gait Posture. 2012 Apr;35(4):535-40
pubmed: 22197290
J Biomech. 2018 May 17;73:185-191
pubmed: 29680311
Diabetes Care. 2001 Feb;24(2):250-6
pubmed: 11213874
J Biomech. 2008;41(5):960-7
pubmed: 18291404
Springerplus. 2016 Oct 19;5(1):1819
pubmed: 27812455
Diabetes Ther. 2017 Dec;8(6):1253-1264
pubmed: 28864841
Diabetes Care. 2002 Aug;25(8):1444-50
pubmed: 12145248
Clin Biomech (Bristol, Avon). 2010 Jun;25(5):476-82
pubmed: 20193974
Foot Ankle Int. 2008 May;29(5):498-501
pubmed: 18510903
Disabil Rehabil. 2003 Jul 22;25(14):807-16
pubmed: 12959361
J Biomech. 1983;16(7):523-37
pubmed: 6619170
Gait Posture. 2013 Sep;38(4):723-8
pubmed: 23583607
Diabetes Care. 2003 Jun;26(6):1790-5
pubmed: 12766111
J Biomech. 2008;41(8):1639-50
pubmed: 18466909
Diabetes Care. 2004 Oct;27(10):2382-5
pubmed: 15451904
Diabetes Technol Ther. 2015 Jun;17(6):405-12
pubmed: 25664904