Biomechanical risk factors for tripping during obstacle—Crossing with the trailing limb in patients with type II diabetes mellitus

• Diabetes mellitus reduced trail toe-obstacle clearance, increasing tripping risk.
• Reduced trailing knee flexion and hip adduction are risk factors for tripping.
• Increased ankle plantar flexor effort is needed in diabetes mellitus.

People with type II diabetes mellitus (DM) are at a high risk of falling especially during more challenging locomotor tasks such as obstacle-crossing. The current study aimed to identify the risk factors for tripping in these patients during trailing-limb obstacle-crossing. Fourteen patients with type II DM with or without mild peripheral neuropathy (PN) and 14 healthy controls walked and crossed obstacles of three different heights while their motion data were measured using a motion capture system and two forceplates. The DM group was found to cross obstacles with significantly reduced trailing toe clearance (p < 0.05), increasing the probability of the foot hitting the obstacle, and thus the risk of tripping. This altered end-point control was associated with significantly reduced knee flexion and hip adduction of the trailing swing limb (p < 0.05), as well as significantly increased ankle plantarflexor moments in the leading stance limb (p < 0.05). Therefore, reduced knee flexion and hip adduction of the swing limb are identified as risk factors for tripping during obstacle-crossing. Increased mechanical demands on the ankle plantarflexors suggest that weakness of these muscles may further reduce the already compromised performance of obstacle-crossing in these patients. The current results showed that obstacle-crossing can be used to detect gait deviations and to identify the associated risk of tripping in patients with type II DM without or at an early stage of PN.