Elsevier

Gait & Posture

Volume 46, May 2016, Pages 188-193
Gait & Posture

Altered joint moment strategy during stair walking in diabetes patients with and without peripheral neuropathy

https://doi.org/10.1016/j.gaitpost.2016.03.007Get rights and content
Under a Creative Commons license
open access

Highlights

  • Patients with diabetic peripheral neuropathy (DPN) ascend and descend stairs slower than controls.

  • Ankle and knee joint moments during stair ascent were lower in patients with DPN.

  • Ankle and knee maximum joint strengths were lower in patients with DPN.

  • DPN patients showed higher ankle and knee operating strengths during stair descent.

Abstract

Aim

To investigate lower limb biomechanical strategy during stair walking in patients with diabetes and patients with diabetic peripheral neuropathy, a population known to exhibit lower limb muscular weakness.

Methods

The peak lower limb joint moments of twenty-two patients with diabetic peripheral neuropathy and thirty-nine patients with diabetes and no neuropathy were compared during ascent and descent of a staircase to thirty-two healthy controls. Fifty-nine of the ninety-four participants also performed assessment of their maximum isokinetic ankle and knee joint moment (muscle strength) to assess the level of peak joint moments during the stair task relative to their maximal joint moment-generating capabilities (operating strengths).

Results

Both patient groups ascended and descended stairs slower than controls (p < 0.05). Peak joint moments in patients with diabetic peripheral neuropathy were lower (p < 0.05) at the ankle and knee during stair ascent, and knee only during stair descent compared to controls. Ankle and knee muscle strength values were lower (p < 0.05) in patients with diabetic peripheral neuropathy compared to controls, and lower at knee only in patients without neuropathy. Operating strengths were higher (p < 0.05) at the ankle and knee in patients with neuropathy during stair descent compared to the controls, but not during stair ascent.

Conclusion

Patients with diabetic peripheral neuropathy walk slower to alter gait strategy during stair walking and account for lower-limb muscular weakness, but still exhibit heightened operating strengths during stair descent, which may impact upon fatigue and the ability to recover a safe stance following postural instability.

Keywords

Diabetes
Peripheral neuropathy
Stairs
Joint moments
Strength

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