The Effect of Exercise on Gait Biomechanics of the Neuropathic Diabetic Foot

Abstract

Background: Diabetic Peripheral Neuropathy is a common complication of diabetes, often leading to lower limb amputation. The associated loss of function often leads to alteration in lower limb biomechanics, resulting in higher plantar pressures due to lack of shock absorption. This study sought to investigate whether a six-week exercise program affects kinetics and kinematics of individuals with diabetes and peripheral neuropathy during gait.
Methods: A prospective, quantitative, quasi-experimental same subject design was employed. Out of 12 participants recruited for this study, 3 were females and 9 were males. The mean age was 66 ± 6.7 years, mean duration of diabetes was 17.6 ± 4.2. They completed a specialized exercise program for six weeks, twice weekly. The kinematics and ground reaction forces were tested using 3D motion analysis and force plates, while plantar pressures and pressure-time integrals were tested via a high-resolution pressure mat.
Results: A statistically significant decrease in peak plantar pressures was found in the hallux, mean difference 15.95 (P=0.01), metatarsal area, mean difference 44.78 (P=0.0005) and heel, mean difference 39.63 (P=0.0005) and in the Pressure-Time Integral at the forefoot (P=0.017), Hip flexion at toe-off, mean difference 1.46 (P=0.007) and knee extension at heel strike with a mean difference of 0.98 (P=0.015) also demonstrated statistically significant changes.
Conclusion: Exercise demonstrated a positive effect on gait parameters, most notably being the reduction in forefoot peak plantar pressure which is known to be one of the area’s most likely to ulcerate in this high-risk population. A twice-weekly 6-week program resulted in changes in gait which could be beneficial to the patient with diabetic peripheral neuropathy.