Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy
Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailm...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-05-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/5/457 |
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| author | Neil D. Reeves Giorgio Orlando Steven J. Brown |
| author_facet | Neil D. Reeves Giorgio Orlando Steven J. Brown |
| author_sort | Neil D. Reeves |
| collection | DOAJ |
| description | Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions. |
| first_indexed | 2024-03-10T11:37:28Z |
| format | Article |
| id | doaj.art-57544ed7052e472dbcb4465e055ee1ec |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T11:37:28Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-57544ed7052e472dbcb4465e055ee1ec2023-11-21T18:45:53ZengMDPI AGMedicina1010-660X1648-91442021-05-0157545710.3390/medicina57050457Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral NeuropathyNeil D. Reeves0Giorgio Orlando1Steven J. Brown2Research Centre for Musculoskeletal Science & Sports Medicine, Departments of Life Sciences and of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UKResearch Centre for Musculoskeletal Science & Sports Medicine, Departments of Life Sciences and of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UKResearch Centre for Musculoskeletal Science & Sports Medicine, Departments of Life Sciences and of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UKDiabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.https://www.mdpi.com/1648-9144/57/5/457diabetic neuropathybalanceunsteadinesswalkingdiabetic foot ulcerfalling |
| spellingShingle | Neil D. Reeves Giorgio Orlando Steven J. Brown Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy Medicina diabetic neuropathy balance unsteadiness walking diabetic foot ulcer falling |
| title | Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy |
| title_full | Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy |
| title_fullStr | Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy |
| title_full_unstemmed | Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy |
| title_short | Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy |
| title_sort | sensory motor mechanisms increasing falls risk in diabetic peripheral neuropathy |
| topic | diabetic neuropathy balance unsteadiness walking diabetic foot ulcer falling |
| url | https://www.mdpi.com/1648-9144/57/5/457 |
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