Segmental foot and lower limb kinematics during gait in individuals with diabetes without peripheral neuropathy

Diabetes is associated with gait abnormalities that may impair foot function and increase the risk of ulceration; however, the extent of segmental foot kinematic alterations and their contribution to these gait abnormalities remain unclear. This study utilized a multi-segment foot and lower extremity model to assess gait kinematics and kinetics in individuals with diabetes without neuropathy.

Eleven individuals with type 2 diabetes without diabetic neuropathy (DM, 53 ± 11 yrs.; 87 ± 16 kg; HbA1C, 7.37 ± 1.80; duration of disease: 75 ± 79 months) and thirteen non-diabetic controls (CON, 46 ± 16 yrs.; 76 ± 14 kg) participated in this study. Segmental foot kinematics and lower extremity joint kinematics and kinetics were recorded during 20 trials of barefoot walking using a three-dimensional motion capture system and force platforms. Gait speed was standardized at 0.89-0.9 m/s. A four-segment foot model, including the hindfoot, midfoot, forefoot, and foot was implemented.

Compared with CON, DM demonstrated significantly greater calcaneal eversion (0-45% GC; p = 0.004, and 68-100% GC; p = 0.013), increased midtarsal dorsiflexion (15-25% GC; p = 0.042, and 35-82% GC; p = 0.003), and increased tarsometatarsal plantarflexion (10-47% GC; p = 0.024).

The observed differences in segmental foot kinematics may reflect diabetes-related biomechanical adaptations, even in the absence of clinically detected diabetic neuropathy, although their underlying mechanisms remain to be established.

The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02062-8.