Alterations in the Lower Limb Joint Moments Precede the Peripheral Neuropathy Diagnosis in Diabetes Patients

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Abstract
Background: Changes in gait patterns in individuals with diabetes and neuropathy are still inconclusive. Our aim was to identify differences in the net intralimb moments distribution and lower limb kinematics during gait in different stage of diabetes. Subjects and Methods: This was an observational cross-sectional study that assessed 38 adults: a control group ( n =12), a group with diabetes ( n =12), and a group with diabetic neuropathy ( n =14). The flexor and extensor joint moment peaks and kinematics of ankle, knee, and hip angles were compared among groups (by analysis of variance). Results: At initial contact, both diabetes groups present more hip flexion and smaller hip extensor moment. During late midstance, hip extension decreases, and flexion moment increases in both diabetes groups. For the same diabetes groups, during push off, the hip is more flexed, and the hip extensor moment decreases. Only for the diabetes group without neuropathy is the knee markedly more flexed, and the extensor moment is higher than in the other groups. At push off, the ankle is less extended in both diabetes groups, but the ankle extensor moment is significantly smaller only in neuropathic subjects. Conclusions: The biomechanical modifications on the gait appeared to be a continuous process that was already revealed in patients without neuropathy. The use of the hip joint as a mechanism of forward progression of the body, instead of using the ankle, was more evident and consistent for the patients with diabetic neuropathy. The knee seems to have a major role in those with diabetes without neuropathy who presented higher extensor moments to support the body during early stance.

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