title: Biomechanical characteristics of peripheral diabetic neuropathy: A systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure.
abstract: BACKGROUND
  Diabetic peripheral neuropathy is an important cause of foot ulceration and limb loss. This systematic review and meta-analysis investigated the effect of diabetic peripheral neuropathy on gait, dynamic electromyography and dynamic plantar pressures.
  
  
  METHODS
  Electronic databases were searched systematically for articles reporting the effect of diabetic peripheral neuropathy on gait, dynamic electromyography and plantar pressures. Searches were restricted to articles published between January 2000 and April 2012. Outcome measures assessed included spatiotemporal parameters, lower limb kinematics, kinetics, muscle activation and plantar pressure. Meta-analyses were carried out on all outcome measures reported by ≥3 studies.
  
  
  RESULTS
  Sixteen studies were included consisting of 382 neuropathy participants, 216 diabetes controls without neuropathy and 207 healthy controls. Meta-analysis was performed on 11 gait variables. A high level of heterogeneity was noted between studies. Meta-analysis results suggested a longer stance time and moderately higher plantar pressures in diabetic peripheral neuropathy patients at the rearfoot, midfoot and forefoot compared to controls. Systematic review of studies suggested potential differences in the biomechanical characteristics (kinematics, kinetics, EMG) of diabetic neuropathy patients. However these findings were inconsistent and limited by small sample sizes.
  
  
  CONCLUSIONS
  Current evidence suggests that patients with diabetic peripheral neuropathy have elevated plantar pressures and occupy a longer duration of time in the stance-phase during gait. Firm conclusions are hampered by the heterogeneity and small sample sizes of available studies.
authors.affiliation: Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia; Movement Analysis Laboratory, Institute of Sports and Exercise Science, James Cook University, Townsville, Australia. Electronic address: malindu.fernando@my.jcu.edu.au.
authors.forename: Malindu
authors.initials: M
authors.lastname: Fernando
authors.forename: Robert
authors.initials: R
authors.lastname: Crowther
authors.forename: Peter
authors.initials: P
authors.lastname: Lazzarini
authors.forename: Kunwarjit
authors.initials: K
authors.lastname: Sangla
authors.forename: Margaret
authors.initials: M
authors.lastname: Cunningham
authors.forename: Petra
authors.initials: P
authors.lastname: Buttner
authors.forename: Jonathan
authors.initials: J
authors.lastname: Golledge
mesh_terms: D001696:Biomechanical Phenomena; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D017719:Diabetic Foot / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D004576:Electromyography; D005545:Forefoot, Human / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D009068:Movement / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology; D011312:Pressure
keywords: Biomechanics; Diabetes complications; Diabetes mellitus; Diabetic foot; Diabetic peripheral neuropathy; Electromyography; Gait; Meta-analysis; Movement analysis; Plantar pressure; Systematic review; Type 1 diabetes; Type 2 diabetes