Diabetology International

, Volume 7, Issue 1, pp 69–76 | Cite as

Association between symptoms of bilateral numbness and/or paresthesia in the feet and postural instability in Japanese patients with diabetes

  • Akiko MorimotoEmail author
  • Nao Sonoda
  • Satoshi Ugi
  • Katsutaro Morino
  • Osamu Sekine
  • Ken-ichi Nemoto
  • Mihoko Ogita
  • Yukako Tatsumi
  • Shin Murata
  • Hiroshi Maegawa
  • Naomi Miyamatsu
Original Article



This study assessed the association between symptoms of bilateral numbness and/or paresthesia in the feet and postural instability in Japanese patients with diabetes.


This cross-sectional study included 303 patients with diabetes, aged 40–88 years, who were referred to an outpatient diabetic clinic between January and July 2013 at Shiga University of Medical Science Hospital. A posturography test was used to evaluate postural sway in patients. Indices of postural sway were the total length and the enveloped area. Analysis of covariance was used to estimate the multivariable-adjusted means of indices of postural sway according to the presence or absence of symptoms of bilateral numbness and/or paresthesia in the feet.


Of 303 patients, 35 (11.6 %) had symptoms of bilateral numbness and/or paresthesia in the feet. After adjustment for age, sex, diabetic retinopathy, regular exercise, body mass index, hemoglobin A1c level, and quadriceps’ strength, patients with symptoms had higher levels of postural sway length and an enveloped area in the posturography test than those without symptoms. In addition, we observed similar results when we analyzed 234 patients aged ≥60 years.


Our findings suggest that patients who had symptoms of bilateral numbness and/or paresthesia in the feet may have more postural instability than those without symptoms.


Numbness Paresthesia Feet Postural instability Diabetes 



This work was supported by the Fund for Care Prevention from NPO Biwako Health and Welfare Consortium and Shiga Prefecture. This work was supported by the Japan Society for the Promotion of Science (JSPS) Grant-in-Aid for Young Scientists (B) (grant no. 25862144). The authors sincerely thank the researchers and medical staff at Shiga University of Medical Science Hospital for their examinations.

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Shiga University of Medical Science, an Ethical Committee) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients included in the study.

Supplementary material

13340_2015_214_MOESM1_ESM.docx (135 kb)
Supplementary material 1 (DOCX 135 kb)


  1. 1.
    Yau RK, Strotmeyer ES, Resnick HE, et al. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care. 2013;36:3985–91.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Volpato S, Leveille SG, Blaum C, et al. Risk factors for falls in older disabled women with diabetes: the Women’s Health and Aging Study. J Gerontol A Biol Sci Med Sci. 2005;60:1539–45.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Schwartz AV, Hillier TA, Sellmeyer DE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care. 2002;25:1749–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Gregg EW, Beckle G, Williams DF, et al. Diabetes and physical disability among older U.S. adults. Diabetes Care. 2000;23:1272–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Schwartz AV, Vittinghoff E, Sellmeyer DE, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31:391–6.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Yamamoto R, Kinoshita T, Momoki T, et al. Postural sway and diabetic peripheral neuropathy. Diabetes Res Clin Pract. 2001;52:213–21.CrossRefPubMedGoogle Scholar
  7. 7.
    Nakatani M, Sasaki H, Kurisu S, et al. Numbness and paresthesia in bilateral toes and soles, and disproportional sweating restricted to face and trunk are suitable symptoms useful for the diagnosis of diabetic symmetric polyneuropathy. J Diabetes Investig. 2011;2:464–73.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Diagnosis Standardization Committee and Insurance Medical Care Committee in Japanese Society for Equilibrium Research. Precision of the stabilometer for medical use. Equilibr Res. 2015;74:44–50 (in Japanese).CrossRefGoogle Scholar
  9. 9.
    Diagnosis Standardization Committee in Japanese Society for Equilibrium Research. Materials for the normalization of equilibrium function test methods. Equilibr Res. 2006;65:468–503 (in Japanese).CrossRefGoogle Scholar
  10. 10.
    The Japanese Society for Equilibrium Research. Illustrated neurotology. 2nd ed. Tokyo: Shindan-to-Chiryo Sha; 2009 (in Japanese).Google Scholar
  11. 11.
    Fujimoto C, Murofushi T, Chihara Y, et al. Assessment of diagnostic accuracy of foam posturography for peripheral vestibular disorders: analysis of parameters related to visual and somatosensory dependence. Clin Neurophysiol. 2009;120:1408–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Fujimoto C, Murofushi T, Chihara Y, et al. Effects of unilateral dysfunction of the inferior vestibular nerve system on postural stability. Clin Neurophysiol. 2010;121:1279–84.CrossRefPubMedGoogle Scholar
  13. 13.
    Chihara Y, Sato A, Ohtani M, et al. The effect of a first-generation H1-antihistamine on postural control: a preliminary study in healthy volunteers. Exp Brain Res. 2013;231:257–66.CrossRefPubMedGoogle Scholar
  14. 14.
    Kashiwagi A, Kasuga M, Araki E, et al. International clinical harmonization of glycated hemoglobin in Japan: from Japan Diabetes Society to National Glycohemoglobin Standardization Program values. J Diabetes Investig. 2012;3:39–40.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRefPubMedGoogle Scholar
  16. 16.
    Massion J, Alexandrov A, Frolov A. Why and how are posture and movement coordinated? Prog Brain Res. 2004;143:13–27.CrossRefPubMedGoogle Scholar
  17. 17.
    Meyer PF, Oddsson LI, De Luca CJ. Reduced plantar sensitivity alters postural responses to lateral perturbations of balance. Exp Brain Res. 2004;157:526–36.CrossRefPubMedGoogle Scholar
  18. 18.
    Loughlin PJ, Redfern MS. Spectral characteristics of visually induced postural sway in healthy elderly and healthy young subjects. IEEE Trans Neural Syst Rehabil Eng. 2001;9:24–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Loughlin PJ, Redfern MS, Furman JM. Time-varying characteristics of visually induced postural sway. IEEE Trans Rehabil Eng. 1996;4:416–24.CrossRefPubMedGoogle Scholar
  20. 20.
    Black AA, Wood JM, Lovie-Kitchin JE, et al. Visual impairment and postural sway among older adults with glaucoma. Optom Vis Sci. 2008;85:489–97.CrossRefPubMedGoogle Scholar
  21. 21.
    Sherrington C, Whitney JC, Lord SR, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008;56:2234–43.CrossRefPubMedGoogle Scholar
  22. 22.
    Allet L, Armand S, de Bie RA, et al. The gait and balance of patients with diabetes can be improved: a randomised controlled trial. Diabetologia. 2010;53:458–66.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kluding PM, Pasnoor M, Singh R, et al. Safety of aerobic exercise in people with diabetic peripheral neuropathy. Phys Ther. 2014. doi: 10.2522/ptj.20140108.
  24. 24.
    Song C, Petrofsky J, Lee S, et al. Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Diabetes Technol Ther. 2011;13:803–11.CrossRefPubMedGoogle Scholar
  25. 25.
    Richardson JK, Sandman D, Vela S. A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil. 2001;82:205–9.CrossRefPubMedGoogle Scholar

Copyright information

© The Japan Diabetes Society 2015

Authors and Affiliations

  • Akiko Morimoto
    • 1
    Email author
  • Nao Sonoda
    • 1
  • Satoshi Ugi
    • 2
  • Katsutaro Morino
    • 2
  • Osamu Sekine
    • 2
  • Ken-ichi Nemoto
    • 2
  • Mihoko Ogita
    • 1
    • 3
  • Yukako Tatsumi
    • 1
    • 4
  • Shin Murata
    • 5
  • Hiroshi Maegawa
    • 2
  • Naomi Miyamatsu
    • 1
  1. 1.Department of Clinical NursingShiga University of Medical ScienceShigaJapan
  2. 2.Department of MedicineShiga University of Medical ScienceOtsuJapan
  3. 3.Department of NursingKyoto Koka Women’s UniversityKyotoJapan
  4. 4.Department of Preventive Medicine and Public HealthNational Cerebral and Cardiovascular CenterSuitaJapan
  5. 5.Department of Physical TherapyKyoto Tachibana UniversityKyotoJapan

Personalised recommendations