The underlying mechanisms of impaired balance in people
with DPN when walking have been recently addressed by
Dingwell et al.16,17 Patients with DPN had greater local “dynamic
stability” (measured by an accelerometer strapped onto
the trunk) than did controls during overground walking, and the
stability of the trunk was more closely associated with walking
speed than with sensory status. It was concluded that neuropathic
patients are not at greater risk of falling because they are
more unstable when walking; rather, the high rates of falls may
result from impaired obstacle avoidance and/or response strategies.