Gait deviations of patients with diabetes mellitus: looking beyond peripheral neuropathy

The aim of this paper was to define the gait deviations in patients with diabetes mellitus (DM), to investigate the associations between electrophysiological findings and gait characteristics, and to interpret the findings in preventive and therapeutic rehabilitation protocols.

Forty-six patients with DM and 20 healthy control subjects were enrolled into this controlled study. Electrophysiological studies and computerized gait analysis were performed. Gait deviations of DM patients with diabetic peripheral neuropathy (DPN) (n=20), without diabetic peripheral neuropathy (NDPN) (n=26) and healthy control subjects (C) (n=20) were compared, and associations between electrophysiological findings and gait characteristics were investigated.

NDPN, but not DPN, group revealed slower gait, shorter steps, limited knee and ankle mobility, lower ankle plantar flexor moment and power than C group, and the difference was statistically significant. HbA1c levels and F-wave latency were significantly correlated with ankle mobility, peak ankle plantar flexion moment and power.

Neuropathy may not be the only reason for gait deviations in DM patients. Considering the spectrum of hyperglycemic complications including the mechanical characteristics of bones, muscles and soft tissues, patients with DM should start mobility and strengthening exercises in early stages.