Postural Control in Diabetic Peripheral Neuropathy: A Narrative Review

Abstract

Diabetes mellitus is a metabolic disease of chronic hyperglycaemia which leads to neurological complications such as Diabetic Peripheral Neuropathy (DPN). When compared to healthy persons, those with DPN are more likely to fall, especially in geriatric population. Present review aims to provide an insight to the pathophysiology, outcome measures, and physiotherapy treatment of impaired postural control in DPN. Searches for relevant articles were conducted using Google Scholar, PubMed, Ovid, Springerlink, Science Direct (SD), Seniorcare Ageing Growth Engine (SAGE), Elton B. Stephens Company (EBSCO) Discovery Service and Web of Science. Keywords used were diabetes, DPN, diabetic foot, postural control, balance, postural sway, physiotherapy intervention. Irrespective of their year of publication, studies and reports published in English, that provide data of postural control in individuals with DPN and its physiotherapy management were included in the study. The included publications were reviewed and a narrative review was formulated. A total of 35 studies were included in this review. All studies suggest that there is postural instability in people with DPN which increases with age and duration of diabetes. Multidirectional postural sway was observed in most of the studies with medio-lateral instability encountered in more cases. Significant improvement in timed up and go test, single leg stance test, Berg balance scale, and other outcome measures post physiotherapy intervention were reported. Literature suggests that multidirectional postural instability is present in DPN patients. Physiotherapy, offloading devices and diabetic foot care education improve postural stability in individuals with DPN.