Postural Instability in Patients with Diabetic Sensory Neuropathy

Simoneau, Guy G.; Ulbrecht, Jan S.; Derr, Janice; Becker, Mary B.; Cavanagh, Peter R.

doi:10.2337/diacare.17.12.1411

Cited by 273 publications

(231 citation statements)

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“…Despite these limitations this study provides evidence that diabetic patients with limited sensory input from under their feet have a declined posture stability, which is in agreement with previous research results (Simmons et al 1997;Uccioli et al 1995;Simoneau et al 1994;Richardson et al 1992;Richardson and Hurvitz 1995;Richardson and Ashton-Miller 1996;Sorock and Labiner 1992;Maki et al 1999;Geurts et al 1993).…”

Section: Effect Of Flat Insoles With Different Shore a Values On Postsupporting

confidence: 92%

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Effect of flat insoles with different Shore A values on posture stability in diabetic neuropathy

Geffen¹,

Dijkstra²,

Hof³

et al. 2007

Prosthetics &Amp; Orthotics International

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The objective of the study was to determine whether insoles with a low Shore A value (158) as prescribed for patients with a diabetic neuropathy have a negative effect on posture stability because these insoles may reduce somatosensory input under the feet. It was conducted in the Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands The study was observational and conducted on 30 diabetic patients (aged 37 -82 years) with a neuropathy. Posture stability (body sway) was assessed in a shoe without insole, on a flat insole with a low Shore A value (158) and on a flat insole with a higher Shore A value (308). These assessments were done under four different conditions: (1) eyes open, no dual-task, (2) eyes closed, no dual-task, (3) eyes open, dual-task (mental arithmetic) and (4) eyes closed, dual-task. Additionally 10 healthy controls (aged 27 -51 years) were assessed similarly. A significantly higher root-mean-square (rms) value of the anterior-posterior velocity, V y , was found in patients compared with controls (3.4 cm/s vs. 1.2 cm/s, p 5 0.05). Also a significant difference in rms value of the anterior-posterior velocity, V y , was found between eyes open and eyes closed (1.9 cm/s vs. 2.7 cm/s, p 5 0.05). No significant effects were found for insoles or dual tasks for the total group. In diabetic patients no significant effect was found of insoles on posture stability. The effect of closed eyes on posture stability was significantly larger for diabetic patients compared to controls. It was found that prescribing insoles with a low Shore A value (158), compared to insoles with a higher Shore A value (308) has no significant negative effect on posture stability in patients with a diabetic neuropathy.

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Section: Effect Of Flat Insoles With Different Shore a Values On Postsupporting

confidence: 92%

“…A significant further decline of posture stability on patients with diabetic neuropathy when visual information was limited was found, supporting evidence already described in literature (Simoneau et al 1994;Maki et al 1999;Giacomini et al 1996).…”

Section: Effect Of Flat Insoles With Different Shore a Values On Postsupporting

confidence: 90%

Effect of flat insoles with different Shore A values on posture stability in diabetic neuropathy

Geffen¹,

Dijkstra²,

Hof³

et al. 2007

Prosthetics &Amp; Orthotics International

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“…The strength at the ankle was not measured, no correction for weight was made, and the relation to presence and severity of neuropathy was not studied. In two studies evaluating gait and posture in diabetic patients with and without neuropathy, quantitative assessment of muscle strength at the ankle in diabetic patients was used, but the type of diabetes was not stated and relations to severity of neuropathy were not sought (26,27). To our knowledge, this is the first study applying quantitative assessment of motor performance in type 2 diabetes to severity of neuropathy and other diabetes complications.…”

Section: Discussionmentioning

confidence: 99%

Muscle Strength in Type 2 Diabetes

Andersen

Nielsén²,

Ce³

et al. 2004

Diabetes

318

267

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Motor function in type 2 diabetes is largely unknown. In 36 type 2 diabetic patients and in 36 control subjects matched for sex, age, weight, height, and physical activity, strength of flexors and extensors at elbow, wrist, knee, and ankle was assessed at isokinetic dynamometry. The degree of neuropathy was determined by clinical scores, nerve conduction studies, and quantitative sensory testing. Eventually, all results were summed to obtain a neuropathy rank-sum score (NRSS). The degree of nephropathy and retinal condition were also evaluated. Diabetic patients had a 17 and 14% reduction of strength of ankle flexors (P < 0.02) and ankle extensors (P < 0.03), respectively. At the knee, strength of extensors and flexors was reduced by 7% (NS) and 14% (P < 0.05), respectively. At the elbow and wrist, muscle strength was preserved. The NRSS was related to the strength at the ankle (r ‫؍‬ ؊0.45, P < 0.01) and knee (r ‫؍‬ ؊0.42, P < 0.02). Following multiple regression analysis, the NRSS but not the degree of nephropathy or retinopathy was related to strength at the ankle and knee. In conclusion, type 2 diabetic patients may have muscle weakness at the ankle and knee related to presence and severity of peripheral neuropathy. Diabetes 53:1543-1548, 2004 S ensory symptoms and deficits are frequent in distal diabetic polyneuropathy. Motor symptoms are less dramatic, and motor deficits are more difficult to recognize. Not surprisingly, the literature on this manifestation of diabetic polyneuropathy is sparse. In patients with long-term type 1 diabetes, we have found impaired muscle strength at the ankle and knee closely related to the severity of neuropathy (2). Motor dysfunction is known to occur in type 2 diabetic patients; however, the severity and distribution of the weakness has not been reported (3).In a population-based study from the U.K., a similar frequency of neuropathy was found in type 1 and 2 diabetic patients after age correction (4). Nevertheless, a considerably lower frequency of severe neuropathy, defined as an inability to walk on heels, was observed in type 2 diabetes in a population-based study from Minnesota (3). This observation may indicate less motor dysfunction in type 2 diabetes. However, the relation between inability to walk on heels and muscle strength has not been established, so there is a clear need for quantitative studies of motor function in type 2 diabetes.In the present study, we evaluated muscular performance of lower and upper extremities quantitatively in type 2 diabetic patients, applying isokinetic dynamometry, which has high reliability in the determination of maximal strength in both neuropathic and healthy subjects (5). To study the relationship of muscle strength with the prevalence and severity of diabetic neuropathy, other diabetes complications, and metabolic control, patients were characterized clinically, biochemically, and with electrophysiological and sensory function tests. RESEARCH DESIGN AND METHODSAll patients and control subjects gave informed consent for partici...

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“…The feet were analyzed barefoot in a Peter Richard Cavanagh (PRC) mask from the Novel scientific software (Fig. 4) [39]. The PRC mask divides the foot into 10 masks: lateral and medial heel; lateral and medial midfoot; forefoot consisting of first, second, and lateral metatarsal heads, hallux, second toe, and lateral toes.…”

Section: Methodsmentioning

confidence: 99%

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Frigg

Nigg

Davis

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The Saltzman-el-Khoury hindfoot alignment view (HAV) is considered the gold standard for assessing the axis from hindfoot to tibia. However, it is unclear whether radiographic alignment influences dynamic load distribution during gait. Questions/purposes We evaluated varus-valgus alignment by the HAV and its influence on dynamic load distribution in ankle and tibiotalocalcaneal (TTC) arthrodesis. Patients and Methods We clinically assessed 98 patients (ankle, 56; TTC, 42) with SF-36 and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual hindfoot alignment, HAV angle, and dynamic pedobarography using a five-step method. For comparison, 70 normal feet were evaluated. Minimum followup was 2 years (average, 4.11 years; range, 2-6 years). Results The mean HAV angle was À0.8°± 7.8°for ankle and À1.2°± 6.9°for TTC arthrodesis. The HAV angle correlated with pedobarographic load distribution (r = 0.35-0.53). Radiographic alignment did not influence SF-36 or AOFAS scores; however, load distribution correlated to qualities of these scores. Visual alignment only predicted the corresponding HAV angle in 48%. To reproduce the dynamic load of healthy subjects, HAV angles of 5°to 10°valgus were needed. Conclusions Visual positioning is inadequate to determine intraoperative positioning and resulted in a varus position with a relatively large SD. The HAV should be used to assess the hindfoot alignment correctly. HAV angles of 5°to 10°valgus are needed to reproduce a physiologic gait pattern.

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Postural Instability in Patients with Diabetic Sensory Neuropathy

Cited by 273 publications

References 0 publications

Effect of flat insoles with different Shore A values on posture stability in diabetic neuropathy

Effect of flat insoles with different Shore A values on posture stability in diabetic neuropathy

Muscle Strength in Type 2 Diabetes

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

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