title: People with diabetic peripheral neuropathy display a decreased stepping accuracy during walking: potential implications for risk of tripping.
abstract: OBJECTIVE
  To examine the stepping accuracy of people with diabetes and diabetic peripheral neuropathy.
  
  
  METHODS
  Fourteen patients with diabetic peripheral neuropathy (DPN), 12 patients with diabetes but no neuropathy (D) and 10 healthy non-diabetic control participants (C). Accuracy of stepping was measured whilst the participants walked along a walkway consisting of 18 stepping targets. Preliminary data on visual gaze characteristics were also captured in a subset of participants (diabetic peripheral neuropathy group: n = 4; diabetes-alone group: n = 4; and control group: n = 4) during the same task.
  
  
  RESULTS
  Patients in the diabetic peripheral neuropathy group, and patients in the diabetes-alone group were significantly less accurate at stepping on targets than were control subjects (P < 0.05). Preliminary visual gaze analysis identified that patients diabetic peripheral neuropathy were slower to look between targets, resulting in less time being spent looking at a target before foot-target contact.
  
  
  CONCLUSIONS
  Impaired motor control is theorized to be a major factor underlying the changes in stepping accuracy, and potentially altered visual gaze behaviour may also play a role. Reduced stepping accuracy may indicate a decreased ability to control the placement of the lower limbs, leading to patients with neuropathy potentially being less able to avoid observed obstacles during walking.
authors.affiliation: School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Handsaker
authors.affiliation: School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Brown
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
authors.forename: F L
authors.initials: FL
authors.lastname: Bowling
authors.affiliation: School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.
authors.forename: D E
authors.initials: DE
authors.lastname: Marple-Horvat
authors.affiliation: Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
authors.forename: A J M
authors.initials: AJ
authors.lastname: Boulton
authors.affiliation: School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Reeves
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003463:Cues; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D004739:England / Q000453:epidemiology; D020234:Gait Ataxia / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009048:Motor Skills; D015835:Ocular Motility Disorders / Q000150:complications / Q000209:etiology* / Q000503:physiopathology; D017933:Peripheral Nervous System / Q000503:physiopathology*; D010865:Pilot Projects; D012306:Risk; D012684:Sensory Thresholds; D012720:Severity of Illness Index; D014732:Vibration; D016138:Walking