As part of the biomechanics track at the Western Foot and Ankle Conference, Cary Costa, DPT, MEd, addressed his perspective on peripheral neuropathy’s impact on balance and gait. He reminded the audience that peripheral neuropathy can impact all 3 types of nerve fibers, including motor, sensory, and autonomic. Due to potential loss of intrinsic mobility and protective sensation, among other factors, patients with peripheral neuropathy, including diabetic peripheral neuropathy, can be at risk of falls and injury. 

Dr. Costa pointed out several gait and balance changes that he notices in his practice in patients with peripheral neuropathy. First, he noted that they may take more steps, and slower steps compared with age-matched healthy patients. He said this may be in part due to the loss of plantar surface sensation, but that reduced ankle motion can also play a role. Dr. Costa mentioned that the changes in ankle range of motion can be present even in those with prediabetes. 

Sarcopenia is an additional important consideration, said Dr. Costa, as this accelerates in states of hyperglycemia, with multiple ramifications in muscle strength and volume. Adding in the impact of increased peak plantar pressures and risk for ulceration, especially in those with diabetic peripheral neuropathy, and the importance of the potential consequences of peripheral neuropathy on mechanics and gait is clear.

Dr. Costa, who practices with OC Sports and Rehab in California, concluded by summarizing the following impacts of peripheral neuropathy on gait that he has also observed in his practice:

• Lower gait velocity
• Shorter stride length
• Longer stride time
• Longer time in the stance phase of gait
• Longer percentage of stance in the gait cycle, proportionally 
• Higher torque at maximum knee extension moment due to increased energy cost to keep balanced
• Decreased gait steadiness with barefoot walking
• Increased falls

When he undertakes physical therapy retraining for patients with peripheral neuropathy, he shared that goals can include decreasing swelling if present, gait retraining via a fully camera-equipped system and treadmill, and working on rigidity/flexibility, weakness, and any other deficits. 

Dr. Costa stated he has no disclosures related to his lecture.