Effect of joint limitation and balance control on gait changes in diabetic peripheral neuropathy

Background: Foot ulcers are the most physically disabling chronic complications of diabetes. Prevention and management of foot ulcers are related to the quality of life and prognosis of diabetic patients. The purpose of this study was to analyze the gait patterns of patients with diabetic peripheral neuropathy and changes in their center of mass sway due to peripheral neuropathy to help prevent the formation of foot ulcers and their recurrence after ulcer healing.
Methods: Forty-two subjects with diagnosis of DM consisted of three groups which were DM group (neither neuropathy nor foot ulcer history), DPN group (with neuropathy and without foot ulcer history), and DFU group (with neuropathy and foot ulcer history). We measured range of motion (ROM) of the lower limb joints at resting position and center of mass sway at standing position. By using 3-D gait analysis, lower limb joint angles in each walking phase and ROM during the during walking, distance factors (step length and step width) were evaluated.
Results: Concerning the knee joint of the DFU group, function limitation at rest was not observed but ROM limitation during walking was detected. Both of the function and ROM limitations were found regarding the ankle joint of the DFU group. The step length ratio and the step width in the DFU group were significantly lower and higher than the DM group, respectively. The sway distances in the DFU group were higher than the DM and DPN group.
Conclusions: It is assumed in DFU group that there is a mixture of functional limitation of the joints themselves and changes in gait due to decreased ability to maintain center of gravity. As diabetic peripheral neuropathy progresses, the gait becomes small, wide and shuffle. Because this gait pattern can induce increased planter pressure and shear forces, supporting joint movement during walking will be able to reduce the incidence and recurrence of foot ulcers.

内容要旨・審査要旨・論文本文の公開
本論文は，著者Hiroyuki Yamasakiの学位論文として提出され，学位審査・授与の対象となっている。
This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use (https://www.springernature.com/gp/open-research/policies/accepted-manuscript-terms), but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s13340-023-00647-9
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