Biomechanical Evolution in the Neuropathic Diabetic Foot: A Scoping Review of Gait and Kinetic‐Kinematic‐Structural Adaptations in Diabetes
G. Di Stasio, R. Colella, D. G. Armstrong, A. Bellingeri, A. De Mola, G. Montini, V. Scotti, A. De Silvestri, F. CampitielloABSTRACT
Background
Gait alterations and biomechanical changes associated with diabetic peripheral polyneuropathy have been described in the literature, but the available evidence remains fragmented. It does not provide a comprehensive overview of how the reported biomechanical patterns differ across clinical stages of the Neuropathic Diabetic Foot (NDF). Mapping these patterns may support an improved understanding of the biomechanical mechanisms underlying increased ulceration risk.
Aim
This scoping review aims to explore and synthesise the existing literature on changes in gait and foot biomechanics in people with diabetes in association with Diabetic Peripheral Neuropathy (DPN) and across its reported clinical stages.
Methods
The scoping review was conducted in accordance with the JBI methodology for scoping reviews and in line with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR). The population included adults with diabetes and peripheral neuropathy, without active foot ulceration, who were managed in community or outpatient settings. The concept of interest is gait and foot‐biomechanical alterations associated with diabetic neuropathy in clinical and biomechanical assessment contexts. A comprehensive search was conducted in PubMed, EMBASE, CINAHL, PEDro, and the Cochrane Library, complemented by grey literature sources including the Trip Medical Database, NICE, and the Guidelines International Network (GIN). Studies published within the last 11 years were considered (2014/12–2026/04). Data were charted and synthesised using a descriptive and narrative approach.
Results
From 2044 initial records, 44 sources met the eligibility criteria. An updated search conducted in April 2026 identified 6 additional eligible sources, resulting in 50 included sources. The evidence mapped across three principal themes: gait and lower‐limb kinematic alterations, changes in plantar loading and joint kinetics, and structural or functional changes of the foot. No included study directly evaluated whether the identified biomechanical alterations predicted the subsequent development of Charcot neuro‐osteoarthropathy.
Conclusions
To our knowledge, this is the first scoping review to map structural, kinematic, kinetic, and plantar‐loading findings within an integrated biomechanical framework of the neuropathic diabetic foot. Because the evidence was predominantly cross‐sectional, the proposed relationships should be interpreted as a conceptual synthesis rather than a demonstrated longitudinal progression. These findings highlight the need for longitudinal studies to investigate the temporal evolution of biomechanical alterations in the neuropathic diabetic foot.