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Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy

Research 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, UK
Author to whom correspondence should be addressed.
Academic Editor: Nikolaos Papanas
Medicina 2021, 57(5), 457;
Received: 24 February 2021 / Revised: 16 April 2021 / Accepted: 30 April 2021 / Published: 8 May 2021
(This article belongs to the Special Issue The Diabetic Foot: Recent Advances and Future Developments)
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. View Full-Text
Keywords: diabetic neuropathy; balance; unsteadiness; walking; diabetic foot ulcer; falling; foot; ankle diabetic neuropathy; balance; unsteadiness; walking; diabetic foot ulcer; falling; foot; ankle
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MDPI and ACS Style

Reeves, N.D.; Orlando, G.; Brown, S.J. Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy. Medicina 2021, 57, 457.

AMA Style

Reeves ND, Orlando G, Brown SJ. Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy. Medicina. 2021; 57(5):457.

Chicago/Turabian Style

Reeves, Neil D., Giorgio Orlando, and Steven J. Brown. 2021. "Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy" Medicina 57, no. 5: 457.

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