Effects of foot-ankle exercises on foot-ankle kinematics, plantar pressure, and gait kinetics in people with diabetic neuropathy: Secondary outcomes from a randomized controlled trial

Author(s)

Monteiro, Renan L. ; Ferreira, Jane S. S. P. ; Silva, Erica Q. ; Cruvinel, Ronaldo H. ; Verissimo, Jady L. ; Bus, Sicco A. ; Sacco, Isabel C. N.

• Document type: Journal article
• Source: BRAZILIAN JOURNAL OF PHYSICAL THERAPY; v. 27, n. 3, p. 11-pg., 2023-05-01.

Abstract

Background: Follow-up report of secondary outcomes of a randomized, single-blinded, parallel controlled trial that investigated the benefits of a foot-ankle therapeutic exercise program on foot-ankle kinematics, plantar pressure, and lower limb kinetics during gait in individuals with diabetic neuropathy (DPN).Methods: Sixty-six participants with DPN were randomly allocated into a control group (CG; n = 31), which received usual care, and an intervention group (IG; n = 35), which received usual care plus a 12-week group-based foot-ankle exercise program. Outcomes were assessed at baseline and 12 weeks by an assessor blinded to group allocation.Results: The generalized linear mixed model and intention-to-treat analysis revealed a greater hip extensor moment at push-off and greater hallux contact area in the IG than CG after 12 weeks. A within-group analysis revealed a larger arch height during stance and higher peak pressure and pressure-time integral at the central forefoot region in the IG after 12 weeks compared to baseline. There were no other significant group difference or changes over time in foot-ankle kinematics or in any other joint moment related to overall lower limb biomechanics.Conclusion: The increases in hip moment at push-off and hallux surface contact area suggest an improvement in the propulsion phase with greater participation of the toes in foot rollover after 12 weeks of a group-based foot-ankle exercises program for people with DPN. Individual face-toface, longer-term, and more intensive interventions may be needed to positively influence foot ankle biomechanics and pressure parameters in other plantar areas.& COPY; 2023 Associacao Brasileira de Pesquisa e Pos-Graduacao em Fisioterapia. Published by Elsevier Espana, S.L.U. All rights reserved. (AU)

• FAPESP's process: 19/02522-0 - Rehabilitation technology for prevention of musculoskeletal and foot dysfunctions of people with Diabetes Mellitus: FootCAre (FoCa) prevention randomized controlled trial
• Grantee: Jane Suelen Silva Pires Ferreira
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 21/00807-8 - Rehabilitation technology for prevention of foot musculoskeletal dysfunctions and treatment of people with Diabetes Mellitus: FOotCAre (FOCA) proof of concept and cost-utility analysis
• Grantee: Ronaldo Henrique Cruvinel Júnior
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• FAPESP's process: 17/17848-3 - Effects of foot muscle strengthening in daily activity and functionality of foot and ankle in diabetic polyneuropathy patients: a randomized controlled trial
• Grantee: Renan Lima Monteiro
• Support Opportunities: Scholarships in Brazil - Doctorate