Clinical factors associated with a conservative gait pattern in older male veterans with diabetes

James S Wrobel,John E Connolly,Ryan T Crews

doi:10.1186/1757-1146-2-11

Abstract

BackgroundPatients with diabetes and peripheral neuropathy are at higher risk for falls. People with diabetes sometimes adopt a more conservative gait pattern with decreased walking speed, widened base, and increased double support time. The purpose of this study was to use a multivariate approach to describe this conservative gait pattern.MethodsMale veterans (mean age = 67 years; SD = 9.8; range 37–86) with diabetes (n = 152) participated in this study from July 2000 to May 2001 at the Veterans Affairs Medical Center, White River Junction, VT. Various demographic, clinical, static mobility, and plantar pressure measures were collected. Conservative gait pattern was defined by visual gait analysis as failure to demonstrate a heel-to-toe gait during the propulsive phase of gait.ResultsPatients with the conservative gait pattern had lower walking speed and decreased stride length compared to normal gait. (0.68 m/s v. 0.91 m/s, p < 0.001; 1.04 m v. 1.24 m, p < 0.001) Age, monofilament insensitivity, and Romberg's sign were significantly higher; and ankle dorsiflexion was significantly lower in the conservative gait pattern group. In the multivariate analysis, walking speed, age, ankle dorsiflexion, and callus were retained in the final model describing 36% of the variance. With the inclusion of ankle dorsiflexion in the model, monofilament insensitivity was no longer an independent predictor.ConclusionOur multivariate investigation of conservative gait in diabetes patients suggests that walking speed, advanced age, limited ankle dorsiflexion, and callus describe this condition more so than clinical measures of neuropathy.

Highlights

Patients with diabetes and peripheral neuropathy are at higher risk for falls
Patients with the conservative gait pattern had lower walking speed and decreased stride length compared to normal gait. (0.68 m/s v. 0.91 m/s, p < 0.001; 1.04 m v. 1.24 m, p < 0.001) Table 1 describes the descriptive characteristics of our population and univariate analysis
Neuropathy, and Romberg's sign were significantly higher; and ankle dorsiflexion was significantly lower in the conservative gait pattern group

Summary

Introduction

Patients with diabetes and peripheral neuropathy are at higher risk for falls. People with diabetes sometimes adopt a more conservative gait pattern with decreased walking speed, widened base, and increased double support time. Patients with diabetes and peripheral neuropathy (DMPN) exhibit gait instability [4,5]. While this may appear trivial to the treating clinician, unsteadiness in gait demonstrated the strongest association with depressive symptoms in a study by Vileikyte and colleagues [6]. Chamberlin and colleagues identified fearful walkers from a Modified Falls Efficacy Scale They found fearful walkers demonstrated a slower walking speed, shorter stride length, and longer double support time than walkers not identified as fearful [7]. Courtemanche and colleagues observed similar findings in DMPN patients They found prolonged reaction times leading the authors (page number not for citation purposes)

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