Clinical Conditions: Peripheral Neuropathy

ABNORMALITIES

Patients suffering from Peripheral Neuropathy have been shown to have the following gait deviations when compared with healthy controls without diabetes or peripheral neuropathy. (Alam, et al., 2017) (Hazari, et al., 2016) (KATOULIS, et al., 1997) (Lamola, et al., 2015) (Mueller, et al., 1994) (Petrovic, et al., 2017):

1. REDUCED SPEED

This is probably related to the proprioceptive deficit that is present in neuropathic patients, causing them to walk more carefully & slower than normal subjects. The slower walking speed can also be due to the decreased plantar flexor strength & ankle mobility found in the such patients.

These deficiencies tend to diminish the ability of the plantar flexor muscles to push off and to generate plantarflexor moments or power during terminal stance, thus resulting in shorter steps and slower walking speed.

2. REDUCED STEP LENGTH

Limited plantar flexion strength secondary to peripheral neuropathy appears to contribute to this change in walking pattern.

Step_length
Step length comparison between Peripheral Neuropathy patients vs Health Controls

3. INCREASED STANCE TIME

Increase_stance_time
Stance phase > 60% in Peripheral Neuropathy patients

4. INCREASED STRIDE WIDTH

With advancing of the disease, patients with Peripheral Neuropathy exhibit a wider base of support during gait, underlining the impaired dynamic control of balance.

5. EFFECT ON JOINT KINEMATICS

a. ANKLE: A Reduction in the ankle plantarflexion & Dorsiflexion is commonly seen in peripheral neuropathy patients. This results in a reduced Ankle ROM. 

The reduced dorsiflexion suggests that patients with DPN are not able to allow the tibia to advance over the foot to the same extent as controls during the mid-stance phase, further evidenced by the reduced knee flexion.

Joint_rom_1
Comparison of Ankle Angle at Initial Contact between Peripheral Neuropathy patients vs Health Controls
Joint_rom_2
Comparison of Ankle Angle at Toe off between Peripheral Neuropathy patients vs Health Controls

b. REDUCED KNEE ROM

Reduced_knee_rom_graph
Knee Angle graph of a Peripheral Neuropathy patient showing reduction in Knee ROM

c. Reduced Hip ROM with increased flexion which is used as a Hip strategy to minimize PPP at forefoot by minimizing push off at ankle

Reduced_HIP_rom_graph
Hip Angle graph of a Peripheral Neuropathy patient showing reduction in Hip ROM & increase in Hip flexion at Toe-off

POINT OF OBSERVATION

Gait patterns for Peripheral Neuropathy are best observed from the lateral view and the posterior view.

RESOURCES FOR FURTHER READING

  1. Alam, U. et al., 2017. Diabetic Neuropathy and Gait: A Review. Diabetes Ther, p. 1253–1264.
  2. Hazari, A. et al., 2016. Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis. SpringerPlus.
  3. Lamola, G. et al., 2015. Quantitative assessment of early biomechanical modifications in diabetic foot patients: the role of foot kinematics and step width. Journal of NeuroEngineering and Rehabilitation.
  4. Mueller, M. J., Sinacore, D. R. & Hoogstrate, S., 1994. Hip and Ankle Walking Strategies: Effect on Peak Plantar Pressures and Implications for Neuropathic Ulceration. Arch Phys Med Rehabil , Volume 75.
  5. Petrovic, M. et al., 2017. Altered leverage around the ankle in people with diabetes: A natural strategy to modify the muscular contribution during walking?. Gait & Posture, pp. 85-90.

Note: The gait patterns described here are based on past researches. Please correlate all observations clinically.