Comparison of Up‐on‐the‐Toes Stand Test Performance in Young Adults and Older Adults With Diabetic Peripheral Neuropathy

Buckley, John G. and Sabouni, Asma and Rodacki, Andre L. F. and Brown, Steve and Reeves, Neil D. (2025) Comparison of Up‐on‐the‐Toes Stand Test Performance in Young Adults and Older Adults With Diabetic Peripheral Neuropathy. Journal of Foot and Ankle Research, 18 (4): e70112. ISSN 1757-1146

Text (jfa2.70112.pdf)
jfa2.70112.pdf - Published Version
Available under License Creative Commons Attribution.
Download (1MB)

Abstract

Background and Purpose: Proficient ankle functioning provides a key contribution to everyday activities, such as walking and stair ascent and descent, where many falls occur. The up‐on‐the‐toes stand test (UTTS), involves rising from standing to an up‐on‐the‐toes position and holding it for 5 s, before lowering back to standing. Here, we explore whether the balance‐related UTTS test scores differ between two groups with expected differences in ankle functioning, that is, between older adults with diabetic peripheral neuropathy (DPN) in comparison to young healthy adults. Design: Case–control study. Methods: On a force platform, 13 older adults with DPN and 14 young adults completed repeated UTTS. Outcome measures were the peak forwards and backwards centre of pressure (CoP) velocity when rising and lowering, the average CoP displacement and variability in CoP velocity when holding the up‐on‐the‐toes position, and the time it was held. Results: In older adults with DPN compared to young adults, the forwards CoP velocity and displacement when rising up‐on‐the‐toes were reduced (p < 0.001), indicating a slower speed and range of movement; variability in CoP velocity when up‐on‐the‐toes was greater, indicating reduced stability (p = 0.021); and time up‐on‐the‐toes was shorter (p = 0.002), indicating a reduced ability to hold this position. Conclusions: Findings indicate that older adults with DPN had poorer UTTS performance in comparison to young adults. This suggests the test might be useful for highlighting how deficits in ankle mobility and function can impact balance when moving up‐on‐the‐toes. Future research should compare (a) older DPN patients with healthy older adults and (b) young adults with older adults, to determine whether UTTS test can validly assess age‐related decline. In addition, case–control designs within the same age group are necessary to determine whether UTTS test can distinguish disease‐specific balance deficits.