Investigation of standing balance in patients with diabetic neuropathy at different stages of foot complications

Kanade, Rajani, Van Deursen, Robert William Martin ORCID: https://orcid.org/0000-0002-9461-0111, Harding, Keith Gordon and Price, Patricia Elaine 2008. Investigation of standing balance in patients with diabetic neuropathy at different stages of foot complications. Clinical Biomechanics 23 (9) , pp. 1183-1191. 10.1016/j.clinbiomech.2008.06.004

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Abstract

Background Diabetic peripheral neuropathy is known to cause postural instability. This study investigated standing balance in patients with diabetic neuropathy with secondary foot complications: foot ulceration, partial foot amputation and trans-tibial amputation, which are expected to pose further challenge to balance control. Methods In this cross-sectional study, 23 patients with diabetic neuropathy alone (controls) were compared with 23 patients with diabetic foot ulceration, 16 patients with partial foot amputation and 22 patients with trans-tibial amputation. Posturography was used to determine the centre of pressure excursion during quiet standing. Differences between the 4 groups were tested using ANOVA and post-hoc comparisons. Findings The 4 groups varied in neuropathy score (P = 0.001) and demonstrated significant decline in balance from neuropathy alone to foot ulceration, to partial foot amputation and trans-tibial amputation based on total excursion of centre of pressure (P < 0.001) and centre of pressure excursion in antero-posterior direction (P < 0.001). The excursion of centre of pressure in medio-lateral direction varied between 4 groups (P < 0.05) however, there was no significant trend. The distance between ankles increased significantly from neuropathy to trans-tibial amputee group (P = 0.001). Post-hoc comparison with controls revealed that each of three study groups demonstrated decreased balance (diabetic neuropathy vs. foot ulceration, P = 0.001, diabetic neuropathy vs. partial foot amputation, P = 0.002 and diabetic neuropathy vs. trans-tibial amputation, P = 0.009). Interpretation Balance deterioration among patient groups from diabetic neuropathy alone to trans-tibial amputation appears to result from bio-mechanical impairment caused by progression of foot complications in addition to postural instability caused by diabetic neuropathy.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Healthcare Sciences
Subjects:	R Medicine > R Medicine (General)
Uncontrolled Keywords:	Diabetic neuropathy ; Standing balance ; Foot ulceration ; Partial foot amputation ; Trans-tibial amputation ; Posturography
Publisher:	Elsevier Health
ISSN:	0268-0033
Last Modified:	17 Oct 2022 10:09
URI:	https://orca.cardiff.ac.uk/id/eprint/7152

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