People with diabetic peripheral neuropathy display a decreased stepping accuracy during walking: potential implications for risk of tripping

Diabet Med. 2016 May;33(5):644-9. doi: 10.1111/dme.12851. Epub 2015 Aug 20.

Abstract

Aim: To examine the stepping accuracy of people with diabetes and diabetic peripheral neuropathy.

Methods: Fourteen patients with diabetic peripheral neuropathy (DPN), 12 patients with diabetes but no neuropathy (D) and 10 healthy non-diabetic control participants (C). Accuracy of stepping was measured whilst the participants walked along a walkway consisting of 18 stepping targets. Preliminary data on visual gaze characteristics were also captured in a subset of participants (diabetic peripheral neuropathy group: n = 4; diabetes-alone group: n = 4; and control group: n = 4) during the same task.

Results: Patients in the diabetic peripheral neuropathy group, and patients in the diabetes-alone group were significantly less accurate at stepping on targets than were control subjects (P < 0.05). Preliminary visual gaze analysis identified that patients diabetic peripheral neuropathy were slower to look between targets, resulting in less time being spent looking at a target before foot-target contact.

Conclusions: Impaired motor control is theorized to be a major factor underlying the changes in stepping accuracy, and potentially altered visual gaze behaviour may also play a role. Reduced stepping accuracy may indicate a decreased ability to control the placement of the lower limbs, leading to patients with neuropathy potentially being less able to avoid observed obstacles during walking.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls*
  • Adult
  • Aged
  • Cohort Studies
  • Cues
  • Diabetes Mellitus / physiopathology*
  • Diabetic Neuropathies / physiopathology*
  • England / epidemiology
  • Gait Ataxia / etiology*
  • Humans
  • Middle Aged
  • Motor Skills
  • Ocular Motility Disorders / complications
  • Ocular Motility Disorders / etiology*
  • Ocular Motility Disorders / physiopathology
  • Peripheral Nervous System / physiopathology*
  • Pilot Projects
  • Risk
  • Sensory Thresholds
  • Severity of Illness Index
  • Vibration
  • Walking