The effect of feet position on standing balance in patients with diabetes

Abstract

Feet displacement is recognized to be an important element in standing and is also linked to postural instability in elderly people with diabetes. This study investigates standing balance in diabetic patients in four asymmetric feet displacements. Quiet standing balance was investigated using the Biodex Balance System in 18 diabetic patients and compared with 18 control elderly subjects. The four standing conditions, namely, comfortable feet position, preferred feet position with a stance width of 17 cm and 15° angle between the medial borders, feet side by side, and heel side by side with a 30° angle between medial edges of feet were evaluated (i.e. eyes opened, eyes closed). The overall stability was calculated by measuring anterior-posterior and medial-lateral indices in standing conditions. Differences among feet positions were compared using an analysis of variance and the independent t-test. The diabetic patients were unstable in the medial-lateral direction when standing with feet side by side versus heel side by side with a 30° angle between medial edges of feet (p = 0.012 and 0.011, respectively), while in controls the anterior-posterior stability scores between standing in preferred foot position with stance width of 17 cm and 15° angle between the medial borders versus feet side by side, and heel side by side with a 30° angle between medial edges of feet versus preferred foot position with stance width of 17 cm and 15° angle between the medial borders had significant difference (p < 0.05). The anterior-posterior stability scores of diabetic subjects with feet side by side versus comfortable foot position (p = 0.047) and heel side by side with a 30° angle between medial edges of feet versus comfortable foot position (p = 0.016) when they closed their eyes during the test had significant difference. Results confirmed that diabetic patients have greater instability in the medial-lateral direction when the base of support reduces and visual clue has an important role in standing balance.

Effects of diabetes mellitus on step length and minimum toe clearance adaptation

“…The older participants with diabetes used biofeedback and reduced errors of foot trajectory adaptation. In line with previous research on foot displacement adaptation in older adults and stroke patients [10,27,[42][43][44][45], this study found that detailed, meaningful information about goal-task performance in each step improved the accuracy of foot displacement. Like other groups, the older diabetic group compared their real-time step length and MTC with presented targets and reduced errors in the steps.…”

The proprioceptive insole: A therapeutic aid for the diabetic patient in prevention?

“…The screening procedures produced results similar to previous observations (Mehdikhani et al, 2014) as well we observed how this protocol had a good impact on patients from all points of view analysed, integrating motor activity with clinical care, and confirming the positive impact of the exercise therapy in diabetic patients (Francia et al, 2014).…”

Techniques and Methods for Testing the Postural Function in Healthy and Pathological Subjects

“…In a bipedal stance, the feet are positioned according to a multitude of possible conditions, the main ones being: feet apart, feet together, semitandem, and full tandem ( Figure 1 ). The legs are generally straight (they can be also flexed if required for the protocol) and the feet either form an angle of 15–30° or are positioned parallel (e.g., [ 113 ]). The intermalleolar distance is usually 5 cm for an angle of 30° and 10–15 cm for an angle of 15° [ 61 , 113 ] and varies between 0 and 15–20 cm for quasi-parallel feet [ 114 ].…”

“…The legs are generally straight (they can be also flexed if required for the protocol) and the feet either form an angle of 15–30° or are positioned parallel (e.g., [ 113 ]). The intermalleolar distance is usually 5 cm for an angle of 30° and 10–15 cm for an angle of 15° [ 61 , 113 ] and varies between 0 and 15–20 cm for quasi-parallel feet [ 114 ]. In a monopedal stance, the supporting leg can be the dominant leg or the nondominant leg according to the aim of the postural test (the dominant leg is the one used for kicking a ball).…”