Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy. Results of a randomized controlled trial

• Grant number: 14/10082-7
• Support Opportunities: Regular Research Grants - Publications - Scientific article
• Duration: June 01, 2014 - November 30, 2014
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Cristina Dallemole Sartor
• Grantee: Cristina Dallemole Sartor
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polineuropathy. Our aim was to investigate the effects of a combined strengthening, stretching, and functional training program on the foot rollover process during gait, described by a combination of biomechanical variables. A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure-time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle. RESULTS: Even though the intervention group primary outcome (PP) showed a not statistically significant increase under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05). The intervention induced a discreet change in foot rollover towards a more physiological process, supported by an improved plantar pressure distribution and a better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy. Trial registration: ClinicalTrials.gov Identifier: NCT01207284 (AU)