Impact of Lower Limb Muscle Strength on Forward Reactive Stepping in Diabetic and Non Diabetic Patients: A Cross-sectional Study

Introduction: Diabetes Mellitus (DM) is a chronic metabolic disorder characterised by persistent hyperglycaemia, which leads to systemic complications affecting the musculoskeletal and nervous systems. This contributes to lower limb weakness, sensory deficits, and impaired postural control, thereby increasing the risk of falls. While most balance assessments focus on anticipatory control. Reactive balance is critical for responding to sudden disturbances, which is often overlooked. The Balance Evaluation System Test (BESTest) includes a reactive balance component, making it a suitable tool for this purpose. Aim: To evaluate the impact of lower limb muscle strength on forward reactive stepping in diabetic and non diabetic patients. Materials and Methods: A cross-sectional study was conducted among 46 diabetic (aged 45-60 years, diabetes duration 3-5 years) and 46 non diabetic individuals in the Department of Endocrinology and Physiotherapy Outpatient Department (OPD) Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India, from February 2025 to April 2025. Diabetic neuropathy patients were excluded using the Diabetic Neuropathy Symptom Score. Handheld Dynamometer (HHD) was used to measure the strength of hips abductors, knee extensors and ankle plantar flexors. Forward reactive stepping was assessed through the compensation stepping correction component of the BESTest, and parameters like First Step Length (FSL) and First Step Time (FST) were analysed using Tracker 6.1.3 software. Pearson’s correlation and Independent t-tests were applied. Effect sizes were reported. Statistical significance was set at p-value