Background: Despite a lack of consensus on its utility, clinicians have traditionally relied on plantar pressure (PP) to predict ulcer risk and prescribe interventions in individuals with diabetic peripheral neuropathy (DPN). Joint kinematics and kinetics have the potential to contribute to DPN assessment and treatment, however previous studies have not accounted for walking speed nor integrated a full-body analysis with a detailed foot model. Purpose: To assess PP and gait alterations in DPN by controlling walking speed and incorporating a multisegment foot model into a full-body gait analysis. We hypothesize that hip and ankle kinetics will be altered consistent with distal muscle weakness. Methods: Ten subjects with DPN (height: 178.79 ± 8.55 cm, weight: 108.78 ± 16.67 kg, age: 61.5 ± 13.53 years), and 10 healthy matched controls (height: 180 ± 6.37 cm, weight: 92.87 ± 14.5 kg, age: 59.4 ± 7.5 years) participated in this cross-sectional study. Fifty-six reflective markers were attached to each subject according to a full-body model, including a multisegment foot. Subjects walked at a controlled speed (1 m/s) while plantar pressure, kinematic and kinetic data were collected. Functional data analysis was used to compare kinematic and kinetic data between groups, while independent t-tests and a Benjamini-Hochburg procedure was used to compare plantar pressure and joint work metrics. Results: Individuals with DPN presented with a delayed transition from hip extension to hip flexion moment and a decrease in peak hip flexion moment. There were no major changes found at the knee. There was an increase in peak dorsiflexion angle and delayed power generation in both the ankle and midtarsal joints. DPN subjects also showed a decreased midtarsal positive work. The only significant PP metric found was a decrease in peak PP under the lateral toes. Conclusion: Findings demonstrated that individuals with DPN use a hip compensation mechanism to overcome distal muscle weakness. Ankle and midfoot alterations are consistent with muscle weakness, requiring proximal compensations. Joint mechanics were more informative than PP measurements and may provide additional insight into DPN assessment and treatment.



College and Department

Life Sciences; Exercise Sciences



Date Submitted


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diabetes, diabetic neuropathy, gait, plantar pressure