Patients with type II diabetes mellitus display reduced toe-obstacle clearance with altered gait patterns during obstacle-crossing

Abstract

Patients with type II diabetes mellitus (DM) have been reported to be at high risk of falls that may be further increased by the effects of challenging activities such as obstacle-crossing. The purpose of this study was to compare the end-point trajectory and joint kinematic and kinetic patterns of the lower extremities between healthy subjects and individuals with DM during obstacle-crossing with the leading limb. Fourteen patients with type II DM, with no to minimal peripheral neuropathy (PN), and 14 healthy controls walked and crossed obstacles of three different heights (10%, 20% and 30% of leg length) while kinematic and kinetic data were measured using a motion analysis system and two forceplates. Compared to normal, the DM group had similar walking speeds and horizontal footobstacle distances but significantly reduced leading toe-obstacle clearances, suggesting an increased risk of tripping over the obstacle. When the swing toe was above the obstacle, the DM group showed greater pelvic anterior tilt, stance ankle dorsiflexion, and smaller swing hip abduction, with reduced hip abductor moments but greater knee flexor and ankle plantarflexor and adductor moments. It is suggested that patients with type II DM, with no or minimal PN, should also be targeted for prevention of falls. Possible therapeutic interventions to decrease falls for those with DM may include strengthening of the knee flexors and ankle plantarflexor muscles, together with proprioception and balance training.