Gait abnormality following amputation in diabetic patients.

Amputations of the lower extremity may result from several etiologic factors. Most amputations performed in the United States result from a dysvascular limb. A majority of the population with vascular impairment comprises people with diabetes. These individuals frequently have comorbidities that may also affect the ultimate outcome of amputation. Loss of protective sensation, propensity toward infection, and visual and balance impairment all create additional issues with postamputation gait in the population with diabetes. Amputations about the foot and ankle affect gait and energy consumption. More gait disturbances tend to be seen as amputation level becomes more proximal; however, loss of the metatarsophalangeal joints has a profound effect, regardless of the proximal level of amputation. Soft tissue balance is key to maximizing gait, particularly prevention of equinus and equinovarus deformity from unopposed plantarflexors. Orthotic, prosthetic, and shoe modifications can help minimize gait abnormalities; however alterations of ground reaction force and center of pressure may still remain.