SLR - March 2010 - Lauren A. Fisher
Reference:
Carter, S. E., Richardson, J. K., Thies, S., DeMott, T., Ashton-Miller, J. A. (2009). The Relationship Between Frontal Plane Gait Variability and Ankle Range of Motion in Middle-Aged and Older Persons with Neuropathy. American Journal of Physical Medicine & Rehabilitation, 88:3.
Scientific Literature Reviews
Reviewed by: Lauren A. Fisher, DPM
Residency Program: Massachusetts General Hospital, Boston MA
Podiatric Relevance:
The evaluation of gait is a fundamental component of both clinical podiatry and podiatric research. Peripheral neuropathy (PN) is a disorder commonly observed and/or diagnosed in podiatric practice. This study examines frontal plane ankle range of motion (ROM) and frontal plane gait variability in middle-aged and older persons in the presence of peripheral neuropathy.
Methods:
History, physical examination, and electrodiagnostic testing were performed on all subjects. Those who were between 45 and 80 years of age, understood English, had the ability to ambulate household distances without an assistive device, and met criteria for a distal, symmetric sensorimotor peripheral neuropathy were included in the study. Those with abnormal vision (despite correction), inability to follow verbal commands, weight > 300 pounds (136 kg), clinically evident central neurologic dysfunction and potentially gait-altering musculoskeletal abnormalities were excluded. Thirty-nine participants, 18 women and 21 men, were studied. Ankle ROM (eversion and inversion) was determined before gait testing using a standard goniometer, performed by either a physical therapist or physiatrist, and measured while subjects were seated with hips and knees flexed at 90 degrees. Ankles were then passively moved, demonstrating the motions of inversion and eversion to the subjects. Each subject was then instructed to actively invert and evert his/her ankles to the greatest extent possible. A goniometer was placed with the stationary arm on the anterior longitudinal midline of the leg and the alternate arm on the dorsum of the foot parallel to the lateral aspect of the second metatarsal. To determine dorsiflexion, the same procedure was followed, but with the goniometer arms placed in the lateral midline of the leg and parallel to the fifth metatarsal. Each motion was determined twice, and the mean of the two measurements was used in data analysis. Gait analysis and kinematic data were processed using a custom algorithm, quantifying step width, step length, & walking speed, and determining step-width variability & step-width range. Statistical analysis was performed using SPSS version 14.0. A P value of <0.05 was considered significant.
Results:
Significant negative correlations were identified between frontal plane ankle ROM and step-width variability as well as step-width range. PN severity also correlated with step-width variability and step-width range. Dorsiflexion ROM did not demonstrate a significant relationship with either step-width variability or step-width range, and age did not demonstrate a relationship between either gait variable or ankle ROM. The relationship between ankle ROM and step-width variability weakened in the presence of PN, with ROM more so than PN demonstrating a stronger association with step-width range (which includes ‘extreme’ steps felt to be precursors to falls).
Conclusion:
Middle-aged and older persons with peripheral neuropathy, who have greater inversion/eversion ROM of the ankle, seem to have improved frontal plane control during gait, as evidenced by decreased step-width variability and step-width range. This effect seems to be, for the most part, independent of peripheral neuropathy severity. If treatment methods to increase ankle frontal plane ROM were to be developed, they may prove helpful in improving ambulation in older persons with or without peripheral neuropathy.