LOWER LIMB JOINT POSITION SENSE IN PATIENTS WITH TYPE II DIABETES MELLITUS
Abstract
Diabetes mellitus (DM), of which type II has been described as an international epidemic, is a major cause of death. Diabetic peripheral neuropathy (PN) is a condition secondary to hyperglycemia, where progressive loss of peripheral nerve function, including sensory and motor functions, occurs over time. Early detection of PN-related impairments may be helpful for the management of patients with DM. Among the methods for the evaluation of these impairments, only that for joint position sense (JPS) requires both motor and sensory involvement. The purpose of the current study was to compare the JPS of the lower limb joints in patients with no or mild diabetic PN to those of normal controls both during weight-bearing (WB) and non-weight-bearing (NWB) conditions using 3D motion analysis methods. The results supported the hypothesis that in well controlled diabetic patients with no or mild PN, JPS deficits can be found only at the ankle joint during WB conditions, resulting in overestimation of dorsiflexion angles. This suggests that at the very early stage of development of diabetic PN, distal joint involvement precedes that of proximal joints. Early detection of these changes, through the assessment of the JPS for all the lower limb joints under both NWB and WB conditions, will be helpful for the development of clinical preventive and treatment programs for patients with DM, even if their glucose level are well controlled. Gait and balance training in these patients should emphasize proprioception training exercises during WB conditions.
