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The Impact of Footwear and Walking Distance on Gait Stability in Diabetic Patients with Peripheral Neuropathy

Bijan Najafi PhD1,2, Tahir Khan DPM2, Adam Fleischer DPM, MPH2, and James Wrobel DPM, MSc2,3
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  • 1 Southern Arizona Limb Salvage Alliance, Interdisciplinary Consortium for Advanced Motion Performance, University of Arizona College of Medicine, Tucson, AZ.
  • | 2 Center for Lower Extremity Ambulatory Research at Scholl College of Podiatric Medicine of Rosalind Franklin University of Medicine and Science, North Chicago, IL.
  • | 3 Metabolism, Endocrinology, and Diabetes Division, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
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Background:

We explored gait differences in patients with diabetes and peripheral neuropathy (DPN) and aged-matched controls over short and long walking distances. The potential benefit of footwear for improving gait in patients with DPN was also explored.

Methods:

Twelve patients with DPN and eight controls walked at their habitual speed over short (7 m) and long (20 m) distances under two conditions: barefoot and regular shoes. A validated system of body-worn sensors was used to extract spatiotemporal gait parameters. Neuropathy severity was quantified using vibratory perception threshold measured at the great toe.

Results:

Gait deterioration in the DPN group was observed during all of the walking trials. However, the difference between patients with DPN and participants in the control group achieved statistical significance only during long walking distance trials. Shod and barefoot double support times were longer in the DPN group during long walking distances (>20%, P = .03). Gait unsteadiness, defined as coefficient of variation of gait velocity, was also significantly higher in the DPN group when barefoot walking over long distances (83%, P = .008). Furthermore, there was a high correlation between neuropathy severity and gait unsteadiness best demonstrated during the barefoot walking/long walking distance condition (r = 0.77, P < .001). The addition of footwear improved gait steadiness in the DPN group by 46% (P = .02). All differences were independent of age, sex, and body mass index (P > .05).

Conclusions:

This study suggests that gait alteration in patients with DPN is most pronounced while walking barefoot over longer distances and that footwear may improve gait steadiness in patients with DPN. (J Am Podiatr Med Assoc 103(3): 165–173, 2013)

Corresponding author: Bijan Najafi, PhD, Southern Arizona Limb Salvage Alliance (SALSA), Interdisciplinary Consortium for Advanced Motion Performance (iCAMP), Arizona Center on Aging, University of Arizona College of Medicine, PO Box 245072, 1501 N Campbell Ave, Room 7342, Tucson, AZ 85724. (E-mail: najafi.bijan@gmail.com or bnajafi@surgery.arizona.edu)