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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although qualitative reports in the surgical literature suggest that people with diabetes mellitus (DM) and transmetatarsal amputation (TMA) walk well with regular shoes and a toe-filler, recent data indicates that this population has multiple complications and difficulty with functional mobility. A thorough description of their gait characteristics may provide insights to the cause of these difficulties. The purpose of this study was to compare selected gait characteristics of people with DM and TMA to age-matched controls. We studied 15 subjects with DM and a TMA, and 15 age-matched controls with an overall mean age of 62.3+/-9.2 years. Data were collected with computer assisted video as subjects walked across a force platform. Range-of-motion (ROM), moments, and power were estimated at the ankle, knee, and hip in the sagittal plane using standard link-segment methods. People with DM and TMA had decreased ROM excursion, peak moments, and peak power at the ankle. At the hip, people with DM and a TMA had decreased ROM excursion, an earlier onset of the hip flexor moment, but no differences in peak moments or peak power. Since people with DM and TMA have reduced ability to generate plantar flexor power at the ankle, they appear to rely more heavily on 'pulling' their leg forward from the hip using their hip flexor muscles. This compensation is not complete, however, as people with DM and a TMA take shorter steps and walk slower than controls. Additional research is needed to determine methods to improve or better compensate for these gait deviations during late stance phase. Copyright 1998 Elsevier Science B.V. All rights reserved
Gait Posture 1998 May 01
PMID:Differences in the gait characteristics of people with diabetes and transmetatarsal amputation compared with age-matched controls. 1020 Mar 85

Patients with diabetes mellitus (DM) and peripheral neuropathy (PN) are at greater risk of falling and of suffering injuries during falls. It has been hypothesized that PN leads to changes in gait variability that may account for this increased risk. The purpose of this investigation was to analyze the variability of the sagittal plane kinematics of diabetic neuropathic (NP), diabetic non-neuropathic (NNP) and age- and weight-matched control subjects (Control) during motorized treadmill walking at constant speed. While there were distinct trends towards increased variability within the three diagnostic groups (NP > NNP > Control) for several measures of gait variability, most of these trends were not statistically significant. We hypothesize that motorized treadmill walking may be inherently less variable than overground walking and that statistical measures of variability may not be sufficient to fully characterize stride-to-stride variability in human locomotion.
Gait Posture 1999 Sep
PMID:Neuropathic gait shows only trends towards increased variability of sagittal plane kinematics during treadmill locomotion. 1046 38

Although plantar flexor muscle strength is known to affect gait characteristics, the effect of plantar flexor (PF) muscle stiffness on gait is unknown. The purpose of this study was to determine the effect of PF muscle stiffness, in addition to PF strength, on the gait characteristics of subjects with diabetes and peripheral neuropathy (DM & PN) and age-matched controls. Thirty-four subjects were tested (17 DM & PN, 17 controls), 10 males and seven females in each group. PF muscle strength (concentric peak torque) explained a significant amount of variance in all gait variables (20-37%). Passive stiffness added a unique contribution to plantar flexor peak moment and walking speed (10-11%). Plantar flexor stiffness, in addition to strength, may be an important factor contributing to gait characteristics. Treatment techniques designed to preserve or increase stiffness may be indicated for patients with limited PF strength.
Gait Posture 2000 Jun
PMID:Effect of plantar flexor muscle stiffness on selected gait characteristics. 1080 33

The aim of this investigation was to assess the potentially different effects of impaired proprioceptive input in balance control under static and dynamic conditions in neuropathic patients. We recruited 20 normal subjects and 27 patients affected by neuropathies known to affect to a different extent large and medium size afferent fibres. The patients comprised 5 with Charcot-Marie-Tooth disease type 1A (CMT1A), 8 with CMT type 2 (CMT2) and 14 with Diabetes polyneuropathy (Diabetics). Measurement of balance during quiet stance on a stabilometric platform showed that sway area (SA) was larger in the CMT2 and Diabetics than normal subjects or in CMT1A, under both eyes open and closed conditions. The estimated conduction velocity (CV) of the group II afferent fibres was lower in CMT2 and Diabetics than in normal subjects and CMT1A. Across all patients, SA increased as a function of the slowing of group II CV. During a dynamic balance task the head A-P displacement was only slightly increased in the patient groups with respect to normals, despite the increased delay at which the head followed displacement of the feet. The unpredictably good performance of all patient groups under dynamic condition, which was at variance with their imbalance during quiet stance, may indicate that these patients learnt to exploit anticipatory postural strategies.
Gait Posture 2006 Apr
PMID:Balance control in peripheral neuropathy: are patients equally unstable under static and dynamic conditions? 1589 62

The purpose of this study was to determine if older persons with a disability have greater utilized coefficient of friction requirements than healthy older and younger adults during various walking conditions. Forty-eight community-dwelling adults were divided into five groups based on medical diagnosis and age: CVA (unilateral stroke; mean age 63 years), DM (diabetes mellitus; mean age 70 years), ARTH (lower extremity arthritis; mean age 69 years), SENIOR (healthy; mean age 73 years), and YOUNG (healthy; mean age 29 years). Ground reaction forces (GRF) were recorded as subjects walked across a walkway, ascended and descended stairs, and negotiated a turn. The utilized coefficient of friction (COF(U)) throughout stance was calculated as the ratio of shear to vertical GRFs, and the peak COF(U) resulting from a shear force that would contribute to a forward foot slip was identified. Separate one-way ANOVAs were used to identify differences in peak COF(U) across subject groups for each walking task. The results of this study found that for all conditions evaluated, those with a disability did not demonstrate greater friction requirements then adults without a disability. Friction requirements for the YOUNG group were significantly greater than all disability groups while negotiating a turn, and were greater than the DM group during level walking. These results indicated that the diagnostic groups evaluated in this study are not at any greater risk for slip initiation than the healthy older or younger adults during the tasks evaluated.
Gait Posture 2005 Aug
PMID:Comparison of utilized coefficient of friction during different walking tasks in persons with and without a disability. 1599 97

Although the postural stability of diabetic patients is affected in the presence of polyneuropathy, it has been suggested that diabetes per se has no effect on balance control during quiet standing. However, recent studies have reported muscular mechanical deficits in patients with type 2 diabetes (T2D) that may be highlighted during a more destabilizing task than quiet standing. Therefore, the objective of this study was to compare non-diabetic and T2D subjects during a modified version of the functional reach (FR) test in order to discriminate differences in postural control associated with diabetes per se. Thirty subjects (15 non-diabetic and 15 T2D) were requested to stand on a force platform and to perform the FR test. Center of pressure velocity (V(COP)), root-mean-square (RMS) amplitude and range of the COP were calculated in the anterior-posterior direction during three specific periods of the FR performance: namely "before", "on-going" and "after". No significant difference between the non-diabetic subjects and the T2D subjects was found for the FR performance. However, T2D subjects had significantly higher V(COP), RMS and range of COP displacements for the "after" period compared to the non-diabetic group (p<0.05). These results suggest that T2D subjects without peripheral neuropathy may have difficulties regaining their stability after a self-initiated reaching task. Therefore, diabetes mellitus per se, could have a direct effect on postural control during standing after a self-induced forward reaching movement.
Gait Posture 2007 Apr
PMID:Postural control following a self-initiated reaching task in type 2 diabetic patients and age-matched controls. 1687 95

The purpose of our study was to examine dynamic foot function during gait as it relates to plantar loading in individuals with DM (diabetes mellitus and neuropathy) compared to matched control subjects. Foot mobility during gait was examined using a multi-segment kinematic model, and plantar loading was measured using a pedobarograph in subjects with DM (N = 15), control subjects (N = 15). Pearson product moment correlation was used to assess the relationship between variables of interest. Statistical significance and equality of correlations were assessed using approximate tests based on Fisher's Z transformation (alpha = 0.05). In individuals with DM, first metatarsal sagittal plane excursion during gait was negatively associated with pressure time integral under the medial forefoot (r = -0.42 and -0.06, DM and Ctrl, P = 0.02). Similarly, lateral forefoot sagittal plane excursion during gait was negatively associated with pressure time integral under the lateral forefoot (r = -0.56 and -0.11, DM and Ctrl, P = 0.02). Frontal plane excursion of the calcaneus was negatively associated with medial (r = -0.57 and 0.12, DM and Ctrl, P < 0.01) and lateral (r = -0.51 and 0.13, DM and Ctrl, P < 0.01) heel and medial forefoot pressure time integral (r = -0.56 and -0.02, DM and Ctrl, P < 0.01). The key findings of our study indicate that reductions in segmental foot mobility were accompanied by increases in local loading in subjects with DM. Reduction in frontal plane calcaneal mobility during walking serves as an important functional marker of loss of foot flexibility in subjects with DM.
Gait Posture 2010 Feb
PMID:Relationships between segmental foot mobility and plantar loading in individuals with and without diabetes and neuropathy. 1992 83

Foot progression angle (FPA) and duration of foot medial column loading during walking were studied in individuals with diabetes mellitus (DM), peripheral neuropathy (PN), and a forefoot ulcer (DMPN), and in age-matched control subjects. FPA was calculated from EMED-ST P-2 pressure maps as the angle formed between the longitudinal axis of the foot and the forward line of progression during walking. The medial loading duration was calculated as the amount of time the center of pressure line spent in the medial side of the foot pressure map. FPA was increased in the DMPN group, on the involved and uninvolved sides [15(9) degrees and 13(4) degrees respectively] compared the control group [9(4) degrees ]. FPA and medial loading duration were significantly correlated in the DMPN group on the involved and uninvolved sides (r>0.54, p<0.036), but were not significantly correlated in the control group (r<|0.07|, p>0.82). This study provides evidence that FPA is an important biomechanical contributor to the pattern of foot loading in individuals with DM, PN, and a forefoot ulcer.
Gait Posture 2010 Jun
PMID:Foot progression angle and medial loading in individuals with diabetes mellitus, peripheral neuropathy, and a foot ulcer. 2057 Jan 53

Deterioration in the function of the sensorimotor system is often seen in patients with diabetes and could be related to balance impairments. The purpose of this study was to determine the association between sensorimotor function and forward reach ability in patients with diabetes. Thirty-one patients with Type 2 diabetes went through a monofilament test of plantar touch-pressure threshold, an ankle joint reposition test for joint position sense, and a series of strength tests of the lower leg. These patients also performed the forward reach test in standing to measure the reach distance and displacement of the center of mass (COM), using a motion analysis system. Correlational and regressional analyses were conducted to determine the association between sensorimotor and balance parameters. It was found that greater reach distance and COM displacement were significantly correlated with lower plantar touch-pressure threshold and greater plantarflexion strength. Regression analysis showed that after controlling the variance in the subject characteristics, plantar touch-pressure threshold was a significant predictor for reach distance and COM displacement, while plantarflexion strength was also a significant predictor for COM displacement. These findings highlight the importance of the assessment of plantar sensitivity and the need for detailed balance or fall risk assessment for patients with impaired plantar insensitivity.
Gait Posture 2010 Oct
PMID:Association between sensorimotor function and forward reach in patients with diabetes. 2082 47

Diabetes may impact gait mechanics before onset of frank neuropathies and other associated threats to mobility. This study aims to characterize gait pattern alterations of type 2 diabetic adults without peripheral neuropathy during walking at maximum speed (fast-walking) as well as at self-selected speed (usual-walking). One-hundred and eighty-six participants aged 60-87 from the Baltimore Longitudinal Study of Aging (BLSA) able to walk unassisted and without peripheral neuropathy were classified as non-diabetic (N=160) or having type 2 diabetes (N=26). Gait parameters from the fast-walking and usual-walking tests were compared between participants with and without type 2 diabetes. Participants with diabetes had a shorter stride length for fast-walking (p=0.033) and a longer percentage of the gait cycle with the knee in 1st flexion for both fast- and usual-walking (p=0.033, and 0.040, respectively) than non-diabetic participants. Participants with diabetes exhibited a smaller hip range of motion in the sagittal plane during usual-walking compared to non-diabetics (p=0.049). During fast-walking, participants with diabetes used lower ankle generative mechanical work expenditure (MWE) and higher knee absorptive MWE compared to non-diabetic persons (p=0.021, and 0.018, respectively). These findings suggest that individuals with type 2 diabetes without overt peripheral neuropathy exhibit altered and less efficient gait patterns than non-diabetic persons. These alterations are more apparent during walking at a maximum speed indicating that maximum gait testing may be useful for identifying early threats to mobility limitations in older adults with type 2 diabetes.
Gait Posture 2011 Oct
PMID:Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy--results from the Baltimore Longitudinal Study of Aging. 2187 64


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