Walking Strategy Abnormalities in Elderly with Diabetic Neuropathy: A Biomechanical Investigation through three Curves Analysis

Abstract

Objective: The aim of the present study was to explore the walking strategy by monitoring the characteristics of plantar pressure in elderly patients with diabetic peripheral neuropathy. Methods: This descriptive study was conducted at the endocrine ward at Huadong Hospital, Fudan University, shanghai, China, from April 2016 to December 2016. Elderly patients with diabetic peripheral neuropathy were enrolled from Huadong Hospital, Fudan University. Non-diabetes elderly were enrolled from Changning District Xianxia Street Community Service Center, Shanghai, China. A total of 229 participants were recruited. Non-diabetic elderly were grouped for DC, and elderly with type 2 diabetes, according to the Toronto clinical neuropathy score (TCSS) into no significant peripheral neuropathy group (DM group), mild peripheral neuropathy group (DN1 group), moderate peripheral nerve lesion group (DN2 group) and severe peripheral neuropathy group (DN3 group), a total of five groups. Outcome measures included the center of pressure (COP)A¯Â¼ÂŒthe plantar force time curve, the Foot balance curve and loading time. Results: COP trajectories: The COP trajectories in elderly with DPN were abnormal significantly with abnormal foldback, beginning point shifted forward and terminal point lateral shifted; The COP excursions along the medio-lateral axes reduced in elderly with DPN and increased in elderly without PN; The COP excursions and maximum excursions along the longitudinal reduced in elderly with DPN; The COP minimum excursions along the longitudinal axis increased in elderly with DPN, with the most severe PN significantly (p<0.05). The plantar force time curve: The plantar force time curve were abnormal significantly in mild and severe PN with single more force peak; Among the morphologically normal curves, the first and second peak force reduced in elderly DM with PN and without PN. The time to peak and valley in elderly DM with PN and without PN delayed (p<0.05). Foot balance: The Foot balance curve were abnormal significantly, with no positive wave or negative wave, with the most severe PN significantly. Among the morphologically normal curves, the positive and negative peak values reduced in elderly with DPN (p<0.05). Loading time: Loading time was significantly longer in the severe PN; In the stance phase of gait cycle, the time of midstance phase were longer, and the time of heel contact phase and propulsion phase were shorter in elderly with DPN and without DPN, with moderate and severe PN more significant (p<0.05); The loading time of the whole foot were prolonged and advanced, The loading time of midfoot and heel were shorten (p<0.05). Conclusions: The gait strategies in elderly with DPN were abnormal including shifted forward of the first loading site, lateral shifted of the final site, poor lateral stability and abnormal reentry, shortage driving force, plantar pressure loading offset, the prolonged loading time, prolonged stance phases and the forefoot ground ahead.