People with diabetic peripheral neuropathy display a decreased stepping accuracy during walking: potential implications for risk of tripping

AimTo examine the stepping accuracy of people with diabetes and diabetic peripheral neuropathy. MethodsFourteen patients with diabetic peripheral neuropathy (DPN), 12 patients with diabetes but no neuropathy (D) and 10 healthy non-diabetic control participants (C). Accuracy of stepping was measured whilst the participants walked along a walkway consisting of 18 stepping targets. Preliminary data on visual gaze characteristics were also captured in a subset of participants (diabetic peripheral neuropathy group: n=4; diabetes-alone group: n=4; and control group: n=4) during the same task. ResultsPatients in the diabetic peripheral neuropathy group, and patients in the diabetes-alone group were significantly less accurate at stepping on targets than were control subjects (P<0.05). Preliminary visual gaze analysis identified that patients diabetic peripheral neuropathy were slower to look between targets, resulting in less time being spent looking at a target before foot-target contact. ConclusionsImpaired motor control is theorized to be a major factor underlying the changes in stepping accuracy, and potentially altered visual gaze behaviour may also play a role. Reduced stepping accuracy may indicate a decreased ability to control the placement of the lower limbs, leading to patients with neuropathy potentially being less able to avoid observed obstacles during walking. What's new? In this study, we examined, for the first time, a specific aspect of gait that may lead to an increased risk of tripping during walking, and which may help explain the increased fall rate in patients in the diabetic peripheral neuropathy group. We showed that patients with diabetic peripheral neuropathy group are less accurate at stepping than control subjects, and theorized how this may lead to a decreased ability to negotiate around potential tripping hazards.