Functional Gait Assessment in Diabetic Neuropathy

Core Assessment Components

The American Diabetes Association recommends that all patients with diabetic peripheral neuropathy should undergo annual functional gait assessment that includes evaluation of kinesthetic and proprioceptive sensation, 10-g monofilament testing, and assessment of balance and mobility using validated tools such as the Timed "Up & Go" Test or Dynamic Gait Index 1, 2
Patients with diabetic peripheral neuropathy should perform 10-g monofilament testing annually to identify loss of protective sensation (LOPS), which is the primary risk factor for foot ulceration and altered gait mechanics 1, 3
Vibration sensation using a 128-Hz tuning fork should be assessed to evaluate large-fiber function, as this directly impacts proprioception during walking 1
Temperature or pinprick sensation should be tested to evaluate small-fiber function 1
Kinesthetic and proprioceptive sensation should be evaluated specifically before recommending any physical activity program, particularly in patients with more severe neuropathy 4, 5, 6

Previous amputation or foot ulcer history is a high-risk feature requiring immediate attention 3
Visible foot deformities, such as hammertoes, prominent metatarsal heads, bunions, or Charcot foot, are high-risk features requiring immediate attention 3
Impaired visual acuity is a high-risk feature requiring immediate attention 3
Concurrent autonomic neuropathy increases risk through postural hypotension, impaired thermoregulation, and decreased cardiac responsiveness 4, 5, 6, 7
Diabetic nephropathy, especially dialysis patients, is a high-risk feature requiring immediate attention 3

Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) should be evaluated at each visit, as diabetes increases disability risk by 50-80%, with lower-body functional limitation being most prevalent (47-84%) 2
Patients with disability impacting functional ability or diabetes self-management capacity should be referred to physical therapy, occupational therapy, or physical medicine and rehabilitation 2

Gait abnormalities occur before clinical neuropathy is evident, and assessment should begin at diabetes diagnosis for type 2 diabetes and after 5 years for type 1 diabetes 1
Moderate-intensity walking is safe and beneficial when proper footwear is used, even in established peripheral neuropathy, and does not increase foot ulcer risk 4, 5, 6, 7
Daily foot examination is mandatory for all patients with peripheral neuropathy to detect lesions early, as decreased pain sensation eliminates the normal warning system for tissue damage 4, 5, 7