Those of us with loss of feeling in our feet and other 
neuropathy can be at a higher risk of falling and stumbling, 
leading to injuries.   Studies indicate that ankle strength 
and mobility can be quite diminished among diabetics and lead 
to changes in the way we walk that can make us more unsteady 
when we walk.   For some of us, this also makes us walk in 
such a way that we put more pressure on the upper soles of our 
feet, which can help lead to foot ulcers.    

      A good physical therapist can help show us how to change 
the way we walk.  An brief examination of range of motion in 
the ankle and analysis of our walking ("gait") can reveal a 
lot to someone trained in the topic.  Exercises and instruction 
in how to move and walk differently could reduce your risks of 
falling and of getting a foot ulcer.  

     If you have lost feeling in your feet or have neuropathy, 
why not make an appointment to have your walking analyzed and 
get some help, to reduce the chances of stumbling and falling?  
Most local hospitals have Physical Therapy departments where 
you can have this done.  If your doctor is reluctant to make 
the referral for gait analysis and correction, why not show him 
these studies from researchers at Washington University in 
St. Louis?   

     Avoiding a fall or a foot ulcer is worth a few appointments 
with a physical therapist! 

			         
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"Differences in the gait characteristics of patients with diabetes
and peripheral neuropathy compared with age-matched controls" by  
Mueller MJ; Minor SD; Sahrmann SA; Schaaf JA; Strube MJ, published 
in Phys Ther, 74: 4, 1994 Apr, 299-308.

Abstract:

BACKGROUND AND PURPOSE. Patients with diabetes and peripheral 
neuropathy have a high incidence of injuries while walking.  
Biomechanical analysis of their walking may lead to treatments 
to reduce these injuries.  The purpose of this study was to 
compare:  (1) the gait characteristics,  (2) the plantar-flexor 
peak torques, and  (3) the ankle range of motion of subjects 
with diabetes mellitus (DM) and peripheral neuropathy with 
those of age-matched controls. 

SUBJECTS. Twenty subjects, 10 with DM and a history of peripheral 
neuropathy (DM group) (mean age = 58 years, SD = 15, range = 35-75) 
and 10 subjects without diabetes (NODM group) (mean age = 57 years, 
SD = 11, range = 37-68), were evaluated. 

METHODS. The following data were collected on all subjects: ankle 
joint mobility, plantar-flexor peak torque (ankle strength), 
kinematics of the trunk and lower extremity during normal walking, 
and ground reaction forces. Moments and power at the ankle, knee, 
and hip during walking were calculated using a two-dimensional 
link-segment model.

RESULTS.   The DM group subjects showed less ankle mobility, ankle 
moment, ankle power, velocity, and stride length during walking than 
the NODM group subjects.  A significant decrease in ankle strength 
and mobility appeared to be the primary factor contributing to the 
altered walking patterns of the DM group. 

CONCLUSION AND  DISCUSSION. The DM group subjects appeared to pull 
their legs forward using hip flexor muscles (hip strategy) rather 
than pushing the legs forward using plantar-flexor muscles (ankle 
strategy), as seen in the NODM group subjects.  Implications for 
treatment are presented to attempt to reduce the number of injuries 
during walking in patients with DM and peripheral neuropathy.

=======

"Hip and ankle walking strategies: effect on peak plantar pressures 
and implications for neuropathic ulceration" by Mueller MJ; Sinacore
DR; Hoogstrate S; Daly L, published in Arch Phys Med Rehabil, 75: 11, 
1994 Nov, 1196-200.

Abstract:

     Treatment of neuropathic plantar ulcers often is directed at 
reducing excessive, repeated peak plantar pressures (PPP). The 
purposes  of this study were to determine whether instructing a 
subject to walk using a hip strategy would reduce forefoot PPP and 
change the kinematics of walking during a single session of testing.  

    Thirteen subjects, 7 with peripheral neuropathy and a history 
of a recent  plantar ulcer, and 6 controls participated. PPPs were 
measured with an in-shoe pressure monitoring system.  Kinematics 
were measured with a computer-assisted motion analysis system. After 
data were collected as subjects walked using their normal walking 
pattern, subjects were instructed to walk using the hip strategy by 
decreasing their push-off, pulling their leg forward from their hips,
decreasing step length, and maintaining their normal walking velocity. 

      Compared with using the normal (ankle) strategy, using the hip 
strategy showed a significant 27% decrease in forefoot PPP and a 24% 
increase in heel PPP. Kinematic changes were decreased plantar flexion 
angular velocity, hip extension range-of motion (ROM), and step length, 
increased dorsiflexion ROM, and hip flexion ROM, but no change in
 walking velocity.

    These findings indicate that a change in walking pattern can result 
in lower forefoot PPP during a single session.  Assuming patients can
maintain the alterations in their walking pattern, these adaptations 
may help to heal  plantar ulcers in some patients with peripheral 
neuropathy.