title: Altered joint moment strategy during stair walking in diabetes patients with and without peripheral neuropathy.
abstract: To investigate lower limb biomechanical strategy during stair walking in patients with diabetes and patients with diabetic peripheral neuropathy, a population known to exhibit lower limb muscular weakness.
  
  
  
  The peak lower limb joint moments of twenty-two patients with diabetic peripheral neuropathy and thirty-nine patients with diabetes and no neuropathy were compared during ascent and descent of a staircase to thirty-two healthy controls. Fifty-nine of the ninety-four participants also performed assessment of their maximum isokinetic ankle and knee joint moment (muscle strength) to assess the level of peak joint moments during the stair task relative to their maximal joint moment-generating capabilities (operating strengths).
  
  
  
  Both patient groups ascended and descended stairs slower than controls (p<0.05). Peak joint moments in patients with diabetic peripheral neuropathy were lower (p<0.05) at the ankle and knee during stair ascent, and knee only during stair descent compared to controls. Ankle and knee muscle strength values were lower (p<0.05) in patients with diabetic peripheral neuropathy compared to controls, and lower at knee only in patients without neuropathy. Operating strengths were higher (p<0.05) at the ankle and knee in patients with neuropathy during stair descent compared to the controls, but not during stair ascent.
  
  
  
  Patients with diabetic peripheral neuropathy walk slower to alter gait strategy during stair walking and account for lower-limb muscular weakness, but still exhibit heightened operating strengths during stair descent, which may impact upon fatigue and the ability to recover a safe stance following postural instability.
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom. Electronic address: s.brown@mmu.ac.uk.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Brown
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Handsaker
authors.affiliation: School of Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom.
authors.forename: Constantinos N
authors.initials: CN
authors.lastname: Maganaris
authors.affiliation: Faculty of Medical & Human Sciences, University of Manchester, United Kingdom.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Bowling
authors.affiliation: Faculty of Medical & Human Sciences, University of Manchester, United Kingdom.
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Reeves
mesh_terms: D000843:Ankle Joint; D001696:Biomechanical Phenomena; D005684:Gait; D006801:Humans; D007719:Knee Joint; D016138:Walking
keywords: Diabetes; Joint moments; Peripheral neuropathy; Stairs; Strength