Gait in people with Diabetes

Question 1

What is Diabetes Mellitus?

Answer 1

Chronic metabolic disorder
Charachterised by hyperglycemia
Results from defects in insulin production/ action or both

Question 2

What are the effects of dibetes on activity levels?

Answer 2

Lower levels of activity in diabetes
Lower maximal walking distance
Slower selected walking distance
Slower maximum walking speed

Question 3

What are the gait problems with people with diabetes?

Answer 3

Those with Diabetic peripheral Neuropathy up to 20x more likely to fall vs aged matched control
Increased Gait variability
Cautious stratergy
Weaker than age matched control
Foot problems such as foot ulcerations
limited lower limb joint stability

Question 4

Why are muscle tendons stiffer in those with diabetes?

Answer 4

Non enzymatic glycation
Increased collagen cross linkin
Implications for energy storage and ulcertion

Question 5

What is neuropathy?

Answer 5

Damage to peripheral nerves
Tingling/numbness
Asymptomatic in majority
Gradual onset
Affect 50% of all diabetes patients

Question 6

What risk factors contribute to neuropathy?

Answer 6

Falls

Foot Ulcerations

Question 7

What are the 3 types of neuropathy

Answer 7

Sensory
Motor
Autonomic

Question 8

What is Quantitive sensory neuropathy testing?

Answer 8

Neuropathy disability score out of 10
measures: hot/cold, sharp/ blunt, vibration and ankle reflexes
>6 out of 10= severe neuropathy

Question 9

What is a callus?

Answer 9

Thickend area of skin

Area of high pressure

Question 10

What is an ulcer?

Answer 10

an open wound/ break in skin

Question 11

What complications arise due to foot ulcers?

Answer 11

Entry for bacteria
High risk of infection/ amputation following infection
25% of diabetics develop foot ulcers

Question 12

What is an ischameia?

Answer 12

Inadequate blood supply due to atherosclerosis of arteries
Leads to development and poor healing of ulcers
Causes healing problems with those with diabetes

Question 13

Charachteristics of plantar pressure in those with diabetes and neuropathy

Answer 13

Higher peak pressure
Higher pressure time integrals
Predispose ulceration

Question 14

What are the contributing factors to plantar pressure?

Answer 14

Neuropathy
Foot deformity (bony prominences)
Reduced ankle dorsiflexion

Question 15

What stratergies are taken to prevent plantar pressure in gait?

Answer 15

Theraputic/ appropriate footwear
Insoles 'total contact delay'
Rocker bottom shoes
Achillies tendon release
Liquid injectable silicone