Lower-limb joint moments during gait in individuals with diabetes with and without peripheral neuropathy - A systematic review with meta-analysis.

Abstract

Altered gait patterns are commonly reported in people with diabetes, particularly in those with diabetic peripheral neuropathy, contributing to impaired balance and a higher fall risk. Lower-limb joint moments quantify the relationship between segment position and the forces acting at the joints. By considering additional points extracted from joint-moment curves, this systematic review with meta-analysis aims to investigate the effects of diabetes and diabetic peripheral neuropathy on lower-limb joint moments during gait. PubMed, Scopus, and Web of Science were searched for studies reporting lower-limb joint moments during gait in people with diabetes, with or without diabetic peripheral neuropathy, up to September 30, 2024. Meta-analyses were carried out on joint moment parameters reported by three or more studies. Twenty-five studies were included, and meta-analyses were performed on 11 studies regarding seven sagittal-plane joint moments. Individuals with diabetes, with and without neuropathy, showed lower ankle plantar flexor and knee flexor moments, while no differences were observed in hip joint moments. No differences between individuals with diabetes and diabetic neuropathy were found. Frontal and transverse plane moments were insufficient for meta-analysis. Evidence indicates reduced plantar flexor and second peak knee flexor moments in people with diabetes, without clear exacerbation by clinically defined neuropathy. This pattern is consistent with gait alterations emerging early in the disease course and suggests that muscular and neuropathy-related kinetic changes may be subtle or not consistently captured by current study methods. Non-significant hip joint moment differences leave competing flexor versus extensor hip strategy explanations unresolved.