Diabetic Neuropathy and Gait: A Review

Abstract

Diabetic peripheral neuropathy (DPN) is a major sequela of diabetes mellitus and may have a detrimental effect on the gait of people with this complication. DPN causes a disruption in the body’s sensorimotor system and is believed to affect up to 50% of patients with diabetes mellitus, dependent on the duration of diabetes. It has a major effect on morbidity and mortality. The peripheral nervous system controls the complex series of events in gait through somatic and autonomic functions, careful balancing of eccentric and concentric muscle contractions and a reliance on the sensory information received from the plantar surface. In this literature review focussing on kinetics, kinematics and posture during gait in DPN patients, we have identified an intimate link between DPN and abnormalities in gait and demonstrated an increased risk in falls for older patients with diabetes. As such, we have identified a need for further research on the role of gait abnormalities in the development of diabetic foot ulceration and subsequent amputations.

Balance, risk of falls, risk factors and fall-related costs in individuals with diabetes

“…This input information is integrated in the brain, together with motor output to the eye and body muscles as effector organs. Ageing, disease, injury and certain drugs can affect one or more of these components, resulting in an elevated risk of balance impairment and gait disorders [3,4]. Diabetes mellitus, for example, may affect sensory input from the feet, resulting in an increased risk of falls, fractures and death [5,6].…”

An artificial intelligence-based deep learning algorithm for the diagnosis of diabetic neuropathy using corneal confocal microscopy: a development and validation study

“…It is an invasive test, needing specialist diagnostic facilities and repeated tests at the same site, which is not always feasible. CCM is a rapid non-invasive ophthalmic imaging modality, which quantifies early axonal damage in diabetic neuropathy with high sensitivity and specificity [12][13][14][15][16]49]. CCM also predicts incident neuropathy [17] and accurately detects CNF regeneration [18,50].…”

Walking on your sensitive sole

“…This deficit implies that the ratio of mass added to Earth during late accretion compared with that added to the Moon is more than 1,000:1, which is substantially different from the predicted ratio 5 of about 20:1. On page 226, Zhu et al 6 show that inefficient delivery of material from glancing impacts, combined with an early hot, molten stage on the Moon, can explain this anomalous input-mass ratio.…”

“…This finding helps to explain the scarcity of precious metals in the Moon relative to Earth. See Letter p.226 6 show that the Moon's ability to retain material from an impactor depends on the angle of the impact with respect to the lunar surface. Lowangle impacts (glancing blows) can result in 80% of the impactor material being lost.…”